Gastrointestinal bleeding Quiz: Ace Your Exams

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A 70-year-old woman is brought to the emergency department for evaluation of fatigue and weakness. The symptoms began 6 months ago and have progressively worsened. The patient has occasionally seen bright red blood in her stool since symptom onset. She denies constipation, straining, or trauma. Past medical history is notable for hypertension and type 2 diabetes mellitus. Her temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 20/min, and blood pressure is 115/68 mmHg. Physical exam shows conjunctival pallor. Cardiac auscultation reveals a harsh ejection-type systolic murmur at the second right intercostal space. Pulmonary and abdominal exams are non-contributory. Fecal occult blood testing is positive. Laboratory testing reveals a hemoglobin of 8.9 mg/dL and serum iron level of 47µg/dL. Endoscopy is performed, and the results are notable for the following:  



Reproduced from: Wikimedia Commons

Which of the following best describes the pathophysiology of this patient’s condition?  

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