WBR0809

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 42 year old patient presents to the emergency department with painful hematemesis. Upon further questioning, the patient denies any past medical or surgical history, intake of any medication, or any allergies. The patient explains that before his symptoms began, he was binging on alcohol and had violent episodes of persistent vomiting after that. In the ED, the patient's vital signs are stable and his physical examination is unremarkable. Following appropriate work-up, the patient undergoes endoscopy. Which of the following best characterizes the pathological process causing this patient's hematemesis?]]
Answer A	AnswerA::Transmural rupture of the esophagus wall.
Answer A Explanation	AnswerAExp::Boerhaave syndrome is characterized by the transmural rupture of the esophagus wall. Boerhaave syndrome is considered an emergency with a high mortality rate.
Answer B	AnswerB::Basal cell hyperplasia, papillary elongation, and inflammatory cell infiltrate in the distal esophagus
Answer B Explanation	AnswerBExp::Gastroesophageal reflux disease (GERD) is characterized by basal cell hyperplasia, papillary elongation, and inflammatory cell infiltrate in the distal esophagus.
Answer C	AnswerC::Increase in portal blood flow with venous congestion at the level of the esophagus
Answer C Explanation	AnswerCExp::Variceal bleeding is caused by portal hypertension commonly due to advanced liver disease. It is characterized by an increase in portal blood flow with venous congestion that eventually causes painless upper GI bleeding.
Answer D	AnswerD::Longitudinal mucosal lacerations in the gastric cardia
Answer D Explanation	AnswerDExp::Mallory-Weiss syndrome is characterized by the longitudinal mucosal lacerations in the gastric cardia.
Answer E	AnswerE::Pseudohyphae and budding spores in the esophageal squamous debris
Answer E Explanation	AnswerEExp::Candida esophagitis is characterized by pseudohyphae and budding spores in the esophageal squamous debris.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Mallory-Weiss syndrome (MWS) is a frequent cause of hematemesis. It is characterized by upper GI bleeding due to the longitudinal mucosal laceration of the distal part of the esophagus or the proximal part of the stomach, the gastric cardia, that causes hematemesis following a submucosal arterial bleed. MWS is commonly caused by violent vomiting and retching in alcoholics and bulimics that cause an increase in intra-abdominal pressure, which is strong enough to cause the gastric cardia to protrude into the thoracic cavity through the hiatus and cause a longitudinal laceration. Educational Objective: Mallory-Weiss syndrome (WMS) is characterized by the longitudinal laceration in the distal esophagus or the gastric cardia. It is a common cause of hematemesis in alcoholics and bulimics. Reference: Morales P, Baum A. Therapeutic alternatives for the Mallory-Weiss tear. Curr Treat Options Gastroenterol. 2003;6(1):75-83. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::mallory, WBRKeyword::weiss, WBRKeyword::syndrome, WBRKeyword::tear, WBRKeyword::mallory-weiss, WBRKeyword::transmural, WBRKeyword::longitudinal, WBRKeyword::laceration, WBRKeyword::hematemesis, WBRKeyword::endoscopy, WBRKeyword::painless, WBRKeyword::painful, WBRKeyword::esophagus, WBRKeyword::esophageal, WBRKeyword::binge, WBRKeyword::vomiting, WBRKeyword::retching, WBRKeyword::severe, WBRKeyword::bulimic, WBRKeyword::bulemia, WBRKeyword::alcoholism, WBRKeyword::alcoholic, WBRKeyword::alcohol, WBRKeyword::mucosal laceration, WBRKeyword::mucosa, WBRKeyword::laceration, WBRKeyword::gastric, WBRKeyword::cardia, WBRKeyword::gastric cardia, WBRKeyword::distal, WBRKeyword::proximal, WBRKeyword::variceal, WBRKeyword::bleed, WBRKeyword::candida, WBRKeyword::esophagitis, WBRKeyword::gastoesophageal reflux disease, WBRKeyword::GERD, WBRKeyword::gastroesophageal, WBRKeyword::reflux, WBRKeyword::disease
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