WBR0447

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 42-year-old man presents to the emergency department for severe epigastric pain that started early in the morning. The patient reports that he had one episode of coffee ground emesis, leading the physician to suspect a bleeding gastric ulcer. Gastroscopy reveals a clean-based benign ulcer in the proximal greater curvature of the stomach, which is believed to be the cause of the patient’s bleeding. Which of the following arteries is most likely perforated in this patient, causing the gastric bleeding?]]
Answer A	AnswerA::Left gastric artery
Answer A Explanation	[[AnswerAExp::Bleeding from an ulcer in the proximal lesser curvature of the stomach is most likely due to perforation of the left gastric artery.]]
Answer B	AnswerB::Right gastric artery
Answer B Explanation	[[AnswerBExp::Bleeding from an ulcer in the distal lesser curvature of the stomach is most likely due to perforation of the right gastric artery.]]
Answer C	AnswerC::Left gastroepiploic artery
Answer C Explanation	[[AnswerCExp::Bleeding from an ulcer in the proximal greater curvature of the stomach is most likely due to perforation of the left gastroepiploic artery.]]
Answer D	AnswerD::Right gastroepipoloic artery
Answer D Explanation	[[AnswerDExp::Bleeding from an ulcer in the distal greater curvature of the stomach is most likely due to perforation of the right gastroepiploic artery.]]
Answer E	AnswerE::Gastroduodenal artery
Answer E Explanation	[[AnswerEExp::Bleeding from an ulcer in the gastric pylorus or the duodenum is most likely due to perforation of the gastroduodenal artery.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Peptic ulcer disease can be complicated by a bleeding ulcer, occuring when an artery in proximity is perforated. The location of the ulcer determines the artery that would most likely be responsible for the bleeding. Proximal lesser curvature - left gastric artery Distal lesser curvature - right gastric artery Proximal greater curvature - left gastroepiploic artery Distal greater curvature - right gastroepiploic artery Pylorus or the duodenum - gastroduodenal artery Educational Objective: Bleeding from an ulcer in the proximal greater curvature of the stomach is most likely due to perforation of the left gastroepiploic artery. References: First Aid 2014 page 336]]
Approved	Approved::Yes
Keyword	WBRKeyword::Peptic, WBRKeyword::ulcer, WBRKeyword::gastroepiploic artery, WBRKeyword::hemorrhage, WBRKeyword::gastroscopy, WBRKeyword::stomach, WBRKeyword::internal bleeding, WBRKeyword::arteries, WBRKeyword::cardiovascular, WBRKeyword::cardiology
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::