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Self-Assessment Questions

Gastroenterology

Gastrointestinal Vascular Disorders: Review Questions

Douglas G. Adler, MD

Dr. Adler is an Assistant Professor of Medicine and Director of Gastrointestinal Endoscopy and Hepatology, University of Texas Health Science Center - Houston, Houston, TX.



Choose the single best answer for each question.

1. A 48-year-old woman with a history of chronic pancreatitis presents to a gastroenterologist for evaluation of melena in the setting of chronic abdominal pain and weight loss. Physical examination reveals a thin, malnourished, chronically ill-appearing woman without focal findings. Upper endoscopy reveals isolated gastric varices, one of which has an adherent clot suggestive of a recent bleed. There are no esophageal varices. What is the most likely cause for the gastric varices?
  1. Hepatic vein thrombosis
  2. Pulmonary hypertension
  3. Splenic artery aneurysm
  4. Splenic vein thrombosis
  5. Superior mesenteric vein (SMV) thrombosis
Click here to compare your answer.


2. A 67-year-old woman presents to the emergency department (ED) for evaluation of a small episode of hematemesis. The patient has a history of hypertension, atherosclerosis, and underwent surgery for an aortic aneurysm 2 years ago. She is hemodynamically stable on arrival. Upper endoscopy reveals a small segment of aortic graft material visible in the third portion of the duodenum without active bleeding. What is the next step in this patient’s management?

  1. Aortic ultrasound
  2. Endoscopic closure of the duodenal defect with metal clips
  3. Observation
  4. Surgical therapy
  5. Tagged erythrocyte scan
Click here to compare your answer.


3. A 50-year-old man with chronic pancreatitis develops melena during hospitalization for an episode of acute-on-chronic pancreatitis brought on by an alcohol binge. Endoscopy reveals blood oozing from the major duodenal papilla but no other abnormalities. A computed tomography scan demonstrates pancreatic changes consistent with chronic pancreatitis, several pseudocysts, a small splenic artery aneurysm, and stones in the gallbladder. What is this patient’s underlying diagnosis?

  1. Hemobilia from the gallstones
  2. Hemosuccus pancreaticus
  3. Infected pancreatic pseudocyst
  4. Splenic vein thrombosis
  5. Underlying pancreatic cancer
Click here to compare your answer.


4. A 73-year-old man with atherosclerosis, diabetes, and hypertension presents to the ED with acute abdominal pain of 1 hour’s duration. The pain was sudden, intense but diffuse, and followed by a large bowel movement that did not improve the patient’s pain. On examination, the patient has a soft, flat abdomen that is diffusely tender but is without organomegaly or peritoneal signs. An abdominal radiograph is suggestive of an ileus without free air. Results of laboratory studies are normal except for an increased lactate level. What is this patient’s most likely diagnosis?
  1. Acute pancreatitis
  2. Acute cholecystitis
  3. Small bowel obstruction with perforation
  4. Superior mesenteric artery (SMA) occlusion
  5. SMV occlusion
Click here to compare your answer.


5. A 17-year-old boy presents to a gastroenterologist for evaluation of anemia. The patient reports occasional painless melena without overt bright red blood per rectum or hematemesis. Physical examination reveals telangiectasias on the lips and tongue but is otherwise normal. Esophagogastroduodenoscopy demonstrates multiple duodenal telangiectasias. What is this patient’s underlying diagnosis?

  1. Celiac sprue
  2. Hereditary pancreatitis
  3. Klippel-Trénaunay-Weber syndrome
  4. Rendu-Osler-Weber syndrome
  5. Sporadic angiectasia
Click here to compare your answer.
 

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