mash
Forum Fanatic
Topics: 147
Posts: 1,326
|
C (mallory weiss tears)
___________________
I hear and I forget. I see and I remember. I do and I understand.
--Confucius
|
| mjl1717
Forum Hero
Topics: 959
Posts: 5,467
|
answer-c-Im thinking (Mallory Weiss) thought more than just the mucosa
was involved.
___________________
Smell the coffee! "Is That an Osler move??"
|
| rida
Forum Guru
Topics: 109
Posts: 721
|
Yes agree with C
___________________
"If He takes you to it, He'll take you through it."
|
| mani
Forum Guru
Topics: 104
Posts: 1,403
|
why not E?? cirrhosis?
is mallory wies painless? i m unsure about it
___________________
Sincerity and hard work are the keys to success!
|
| Renegade
Forum Elite
Topics: 18
Posts: 171
|
I agree with Mani. Painless vomiting does not suggest Mallory Weiss, quite on the contrary, since they think the tearing is caused by the effort when u vomit (there's a proper name for this... which I can't remember at the moment :-k ). Now, since the pt had a long history of alcohol abuse, it's very likely that esophagic vein ruptured as a consequence of portal HTN... caused by cirrhosis. E it is! <:flag:>
___________________
«The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.» W. Osler
|
| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
|
Retching they call it ... that effort :-)
I d go for E.. painless is the key i think. Portal HTN due to Cirhosis, Esoph varicies, bleeding to stomach, then vomiting. The only thing is that blood may not be all that bright red.
___________________
"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson
|
| asmi
Forum Hero
Topics: 1043
Posts: 4,609
|
I agree "painless is the clue"..E seems the best choice
|
| mjl1717
Forum Hero
Topics: 959
Posts: 5,467
|
I cant see the words heartburn, esophagitis, odynophagia, dysphagia, the pain of esophageal ulcers (a complication of GERD) causing the same pain as gastric and duodenal ulcers :arrow: all referring to GERD being described as "painless vomiting."
M.W. can be with or without pain.
Boerhaaves syndrome is a severe esophageal rupture.
Esophageal varices involves a rupture of the l. gastric and azygous vein. I stand corrected because looking at the B.P. this kind of rupture would cause such a low B.P.
___________________
Smell the coffee! "Is That an Osler move??"
|
| Ahab
Forum Elite
Topics: 9
Posts: 228
|
Key words are long hx alcohol abuse, v. low bp indicating severe bleeding, painless vomiting of bright red blood and the source of the rupture is in the lower esophagus.
Leads me to say the answer is E.
I rule out a mallory weis tear based on the painless vomiting and the lack of a history of preceding retching/vomiting that did not contain blood.
Also correct me if I am wrong but are not mallory weis tears found in the anterior part of the gastro-oesophageal junction?
|
| digitaldoc
Topics: 35
Posts: 369
|
Yes the answer is E - this is an NBME question :-) :P
___________________
USMLEtoMD : MY FUN TIPS-N-TRICKS !
|
| Study.Turtle
Forum Newbie
Topics: 2
Posts: 13
|
My answer: E. Most likely cause of UGI bleeding:
1. PUD - 55%
2. Esophegeal varies - 14%
3. AVM - 6%
4. Mallory-Weiss Tear - 5%
The mortality rate for variceal bleeding from portal htn is 70-80% when left untreated. In contrast, a simple mallory-weiss tear (no portal htn) usually heal within 24-48 hours. (The patient died in my practice test-booklet que).
Why not mallory-weiss?
1. Is usually accompanied by preciptating factors causing intrabdominal pressure - retching, lifting, coughing
2. may accompany by epigastric or back pain
3. Is commonly accompanied by hx of vomiting or retching
Source:UTD
|
| Addicudo
Forum Guru
Topics: 124
Posts: 615
|
huMm It has to be .. (E) ... Esophageal Varix ..
But can some one tell me the relation of PAIN to Mally Wiess and Esop varices ? ! ...
And in this question is PAINLESS a clue .. I think .. the clue to the answer is Chronic Alchol intake ... and also that .. as others said Retching is NOT mentioned !
___________________
... Idle hands are the DeVilS play ground ...
|
| Study.Turtle
Forum Newbie
Topics: 2
Posts: 13
|
"Addicudo" wrote:
huMm It has to be .. (E) ... Esophageal Varix ..
But can some one tell me the relation of PAIN to Mally Wiess and Esop varices ? ! ...
And in this question is PAINLESS a clue .. I think .. the clue to the answer is Chronic Alchol intake ... and also that .. as others said Retching is NOT mentioned !
M.W. may or may not present with pain, but varices bleeding is painless. My take is that this is evidence in favor of varices.
My take on the key to this Q is ETOH abuse in combination with the significant bleeding (BP 80/0) presentation. For M.W., pt may have ETOH abuse, but the bleeding presentation is usually non-lethal and self-healing in 24-48h. Other clues that are not in this case (no-pain, no retching episodes) make MW less likely.
|
| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
|
very guud explanation 
___________________
life is guud
|
|
| |
| | | | | | | | | | | | | | |
