anyone please? - ghostwhowalks

[ArchivalUser]

A 28-year-old man who lives in a small rural township is admitted to the hospital because of gastrointestinal bleeding. On admission the patient is pale and has orthostatic hypotension. Hemoglobin concentration is 8 g/dL. His condition is stabilized. Emergent upper endoscopy shows a visible gastric vessel, which is treated appropriately.

Item 1 of 2

17. Specific additional history should be obtained regarding which of the following?

A) Consumption of alcoholic beverages

B) Family history of cancer

C) Source of drinking water

D) Travel history

E) Use of tobacco products

Item 2 of 2

18. Which of the following is the most appropriate laboratory study?

A) Antibodies for Helicobacter pylori

B) Vitamin B12 (cyanocobalamin) concentration

C) Ferritin concentration

D) Gastrin concentration

E) Iron concentration

[ArchivalUser]

Gi bleed in young pt. Pale w/ ortho hypotension which implies at least 20% blood loss. Hg is 8. UGI endo shows gastric vessel. At such a young age w/o anything else in hx u got to suspect EtOH. Correct me if I am wrong:
17. Answer: A
18. The most common cause of stomach ulcers is H. pylori so r/o it out as concomitant.
Answer: A

[ArchivalUser]

agree:

A.EtOH
B. H.pylori

[ArchivalUser]

family history of cancer. a single visible bleeding vessle in gastric area is highly suggestive of carcinoma. EtOH will usually show gastric varices due to portal hyperstension and NOT a single vessel.

check for gastrin concentration to R/O gastrinoma.

[ArchivalUser]

B..
D..

[ArchivalUser]

karan,
i think in a 28 y/o the questions emphasis should be on PUD rather than Gastric CA. Common cause of PUD, alcohol especially in rural america. But GI guy is obligated to bx the ulcerated lesion that is revealing the visible vessel. I agree with ruling out ZE with gastrin level, however, more likely due to H.pylori. I don't think there's a wrong or right to this question. But for exam purposes I will stick with "most commons".