Chapter 14. Stomach
A 45-year-old male presents with sudden onset of severe abdominal pain and recurrent retching with inability to vomit. Attempts at placing an NG tube are not successful. What is the most likely diagnosis?
A. Small-bowel obstruction
Answer: D. This is a classic presentation of gastric volvulus with the Borchardt triad. Two-thirds of the gastric volvulus are organoaxial with the rest being mesenteroaxial.
A 65-year-old male presents with prolonged vomiting. He undergoes an EGD and is diagnosed with a gastric outlet obstruction. Which of the following would correspond with the metabolic abnormality seen with this type of patient?
A. Hypochloremic, hypokalemic metabolic alkalosis
B. Hyperchloremic, hyperkalemic metabolic acidosis
C. Hyponatremic, hypochloremic metabolic acidosis
D. Hypernatremic, hypochloremic metabolic alkalosis
Answer: A. With prolonged vomiting and loss of hydrochloric acid and potassium, a hypochloremic, hypokalemic metabolic alkalosis is encountered. Primary treatment is replacement of lost volume with normal saline.
A 55-year-old critically ill intubated patient has a large amount of bloody drainage from his NG tube. He is hemodynamically labile and received 8 U of PRBC and is not coagulopathic. What is the next step in treatment of this patient?
B. Observation with IV PPI
D. Operative intervention
Answer: D. The patient is hemodynamically labile and has already received 8 U of PRBC. He needs to go to the operating room for operative intervention, which would include exploratory laparotomy, gastrotomy, and oversewing of bleeding areas. If the patient is stable preoperatively, a highly selective vagotomy or a pyloroplasty and truncal vagotomy can be performed.
A 35-year-old woman underwent an EGD, which shows a prepyloric ulcer. What type of ulcer is this?
Answer: C. A type III ulcer is located in the prepyloric area. Management includes antrectomy with incorporation of the ulcer and vagotomy.
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