q.4 - meti

[ArchivalUser]

A 32-year-old female with anorexia nervosa
complains of chronic epigastric pain, nausea,
and bilious vomiting. Her symptoms are
relieved when she assumes a knee to chest
position. The etiology of the disorder is most
likely which of the following?

(A) compression of the bowel by the inferior
mesenteric artery
(B) kinking and obstruction of an afferent
loop
© obstruction of the third portion of the
duodenum
(D) obstruction from a cholangiocarcinoma
(E) obstructing gastric ulcer

[ArchivalUser]

C???

[ArchivalUser]

B. sounds logical. Dont know.

[ArchivalUser]

C.

I got this ans. from the clue 'billous vomiting'.
I didn't know the exact mecha -- "loss of retroperitonial fat cushion".
interesting, right!



The superior mesenteric artery arises
directly from the aorta and crosses in front of
the third portion of the duodenum to enter the
root of the mesentery.

Superior mesenteric artery compression syndrome occurs when the
acute angle between the aorta and superior
mesenteric artery results in compression of the
third portion of the duodenum.

This syndromeusually occurs in young, thin women who
have a loss of the retroperitoneal fat cushion.
The syndrome is also known as œcast syndrome
because of its association with patients
in body casts.

Symptoms include bilious vomiting
and postprandial pain.

Medical treatment
consists of eliminating all contributing factors
(such as casts), lying in the supine position,
and increasing weight. Surgery is reserved for
those who fail conservative measures. Surgical
interventions include releasing the ligament of
Treitz, which moves the duodenum out from
beneath the superior mesenteric artery, or
bypassing the obstruction. (Schwartz et al., 1999