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Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Anatomy, Pathology |SubCategory=Gastrointestinal |MainCategory=Anatomy, Pathology |SubCategory=Gastr..."
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Anatomy, Pathology
|MainCategory=Anatomy, Pathology
Line 20: Line 20:
|MainCategory=Anatomy, Pathology
|MainCategory=Anatomy, Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 42 year old male patient presents to the emergency department with severe epigastric pain that is worsened by food intake.  The patient also reports that he had one episode of coffee ground vomiting earlier this morning.  The physician suspects a bleeding gastric ulcer.  Gastroscopy reveals a clean-based ulcer not suspicious of malignancy in the proximal greater curvature of the stomach that is believed to be the cause of the patient’s bleeding.  Which of the following arteries is most likely perforated in this patient and causing the gastric bleeding?
|Prompt=A 42-year-old male presents to the emergency room with severe epigastric pain that worsens with food intake.  The patient reports that he had one episode of coffee ground vomiting earlier this morning, leading the you 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?
|Explanation=[[Peptic ulcer disease]] can be complicated by a bleeding ulcer when an artery in proximity is perforated. The location of the [[gastric ulcer]] can identify which artery is responsible for the bleeding.  A gastric ulcer in the [[proximal lesser curvature]] bleeds due to perforation of the [[left gastric artery]]; whereas ulcer in the [[distal lesser curvature]] corresponds to a perforation of the [[right gastric artery]].  Similarly, an ulcer in the [[proximal greater curvature]] most probably perforates the [[left gastroepiploic artery]]; whereas an ulcer in the [[distal greater curvature]] is most likely to affect the [[right gastroepiploic artery]].  Finally, an ulcer in the [[pylorus]] and the [[duodenum]] most likely perforate the [[gastroduodenal artery]].
|Explanation=[[Peptic ulcer disease]] can be complicated by a bleeding ulcer, occuring when an artery in proximity is perforated.
 
Location of ulcer - artery most likely responsible for 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]]
 
|EducationalObjectives= Bleeding from an ulcer in the [[proximal greater curvature]] of the stomach is most likely due to perforation of the [[left gastroepiploic artery]].


Educational Objective:
Bleeding from an ulcer in the proximal greater curvature of the stomach is most likely from the left gastroepiploic artery.


|AnswerA=Left gastric artery
|AnswerA=Left gastric artery
 
|AnswerAExp=Bleeding from an ulcer in the [[proximal lesser curvature]] of the stomach is most likely due to perforation of the [[left gastric artery]].
|AnswerAExp=Bleeding from an ulcer in the proximal lesser curvature of the stomach is most likely from the left gastric artery.
|AnswerB=Right gastric artery
|AnswerB=Right gastric artery
 
|AnswerBExp=Bleeding from an ulcer in the [[distal lesser curvature]] of the stomach is most likely due to perforation of the [[right gastric artery]].
 
|AnswerBExp=Bleeding from an ulcer in the distal lesser curvature of the stomach is most likely from the right gastric artery.
|AnswerC=Left gastroepiploic artery
|AnswerC=Left gastroepiploic artery
 
|AnswerCExp=Bleeding from an ulcer in the [[proximal greater curvature]] of the stomach is most likely due to perforation of the [[left gastroepiploic artery]].
|AnswerCExp=Bleeding from an ulcer in the proximal greater curvature of the stomach is most likely from the left gastroepiploic artery.
|AnswerD=Right gastroepipoloic artery
|AnswerD=Right gastroepipoloic artery
 
|AnswerDExp=Bleeding from an ulcer in the [[distal greater curvature]] of the stomach is most likely due to perforation of the [[right gastroepiploic artery]].
|AnswerDExp=Bleeding from an ulcer in the distal greater curvature of the stomach is most likely from the right gastroepiploic artery.
|AnswerE=Gastroduodenal artery
|AnswerE=Gastroduodenal artery
|AnswerEExp=Bleeding from an ulcer in the gastric pylorus or the duodenum is most likely from the gastroduodenal artery.
|AnswerEExp=Bleeding from an ulcer in the gastric [[pylorus]] or the [[duodenum]] is most likely due to perforation of the gastroduodenal artery.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Peptic, ulcer, gastroepiploic artery, hemorrhage, gastroscopy, stomach
|WBRKeyword=Peptic, ulcer, gastroepiploic artery, hemorrhage, gastroscopy, stomach, internal bleeding, arteries, cardiovascular, cardiology
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:01, 23 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Anatomy, MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 42-year-old male presents to the emergency room with severe epigastric pain that worsens with food intake. The patient reports that he had one episode of coffee ground vomiting earlier this morning, leading the you 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.

Location of ulcer - artery most likely responsible for bleeding:

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: ]]

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::
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