WBR0447
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Anatomy, MainCategory::Pathology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[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?]] |
| 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 from 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 from 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 from 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 from 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 from the gastroduodenal artery. |
| Right Answer | RightAnswer::C |
| Explanation | [[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.
Educational Objective:
Bleeding from an ulcer in the proximal greater curvature of the stomach is most likely from the left gastroepiploic artery. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Peptic, WBRKeyword::ulcer, WBRKeyword::gastroepiploic artery, WBRKeyword::hemorrhage, WBRKeyword::gastroscopy, WBRKeyword::stomach |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |