pearljam59
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A 49-year-old man comes to the physician because of fatigue, lightheadedness on standing or sitting up rapidly, and dark-colored stools for the past 4 days. He moved to the USA from southeastern Asia 2 years ago. His history includes chronic hepatitis B infection. Examination shows pale mucous membranes, an enlarged liver, a prominent periumbilical venous pattern, and nonbleeding internal hemorrhoids. Hemoglobin concentration is 7.8 g/dL. Upper endoscopy shows circumferentially prominent tortuous veins with an adherent clot at the gastroesophageal junction. Which of the following mechanisms best explains the blood loss in this patient?
A. Acute inflammation of the gastroesophageal mucosa
B. Arteriovenous fistulae at the gastroesophageal junction
C. Hepatic artery obstruction with increased celiac pressure
D. Increased flow through collateral hepatic veins
E. Increased pressure in submucosal esophageal veins
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| vanshita
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D?
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| nida
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E.
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| druas
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E?
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| lakshya
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Yes, i think E. Because Chronic Hepatitis leads to cirrhosis, which in turn leads to portal vein obstruction-portal hypertension- esophageal varices-bleeding, suggested by the malena( dark colored stool) history.
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| robin082006
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E ie most suitable
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| doc179
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yes E
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| twesting2173
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wouldn;t he be vomiting up the blood if it was e?
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| yasmeen
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NOT NECESSARILY
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| Leo 77
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in normal ppl..no portosystemic anastomosis exists
in cirrhosis...collaterals open not just increase in the normal submucosal veins
its new collaterals...D
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| young_doc
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How would the opening up of collaterals account for "blood loss"?
I say E.
And yes the melena suggests upper GI bleed, and esophageal varices don't necessarily have to make you cough up blood.
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| mediocre
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Eeeeee!!
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| klimt
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E for sure
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| vallia
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agree with E
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| drarnab
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simple .. E..
dark stool = malaena = upper GI blled.
h/o elevated Portal pressre
anyplace where bleeding can occur in such a situation.. no no no!..
however.. the question shdnt be framed as "increased pressure in ........"
as it just means varices are present.
varices have to 'rupture' for there to be bleeding. neway...
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| ManuNastai
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E
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| proctalgia
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Yes E
history says every thing.
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| drfax
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E. esophageal varices is most common result from cirrhosis
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| mohelgamal
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first collaterals are always there they just open
it is E %
and the patient may bleed up to a 1500 cc of blood before hematemsis start to appear
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| StemCell
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I think is E, cause esophageal varices - Portal Hypertension - Cirrhosis
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