lam79m
Forum Junior
Topics: 6
Posts: 43
|
A 52 y old patient arrives to the emergency department with severe abdominal pain radiating towards the back and vomiting. Clinical and laboratory diagnosis of an acute pancreatitis was made and subsecuent treatment was given which improved the patients condition. After a few days the patient begins with black stools and hemodynamic instability which was resolved with normal saline and inotropics. Upper endoscopic studies were made revealing no varices in esophagus nor visible lesions in the body of the stomach, but there was fresh blood in the stomach. Which of the following vessels would most likely be involved in this complication?
a) short gastric veins
b) left gastric veins
c) portal vein
d) right gastric vein
e) great pancreatic vein.
|
| sosikan
Forum Junior
Topics: 3
Posts: 78
|
b?
|
| lam79m
Forum Junior
Topics: 6
Posts: 43
|
This one is tough!,
Pancreatitis is a cause of splenic vein thrombosis which could lead to selective varices in the fundus of the stomach through the short gastric vessels. Varices in the esophagus are not always visible and one may miss it if the endoscope is not flexed towards the fundus.
|
| lam79m
Forum Junior
Topics: 6
Posts: 43
|
1: Arch Surg. 1986 Jun;121(6):723-5. Related Articles, Links
Isolated splenic vein thrombosis.
Glynn MJ.
Isolated splenic vein thrombosis may lead to a specific clinical presentation, namely, bleeding from isolated gastric varices (which are difficult to diagnose), splenomegaly, and normal liver function. The most common cause is pancreatic disease. To exclude associated portal venous thrombosis, angiography is essential prior to a splenectomy, which is curative of the variceal hemorrhage. Splenic vein thrombosis may also be noted as an incidental finding during angiography. Although the natural history is uncertain, a splenectomy is probably not indicated until a hemorrhage occurs.
PMID: 3707347 [PubMed - indexed for MEDLINE]
------------------------------------------------------------------------- -------
|
| smal
Forum Guru
Topics: 140
Posts: 727
|
ya,intresting point.i didnt know about splenic v. thrombosis.
ya ans,A.
___________________
remedy for weakness is not brooding over it ,but thinking of strength.
|
| ManuNastai
|
wow, I can't believe I responded right! 
|
|
| |
| | | | | | |
