NBME - Anybody knows the answer? GI q - matchabc

[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]

Please anybody could help me to think in these ones?

[ArchivalUser]

Hi,
I think the right aswers are already marked here by interrogation signs . It's screening of portal hypertension causes : alcohol abuse and hemochromatosis.

[ArchivalUser]

Visible gastric vessel in EGD has 2 possiblities

1. Acid peptic disorder
2. Sinistral Hypertension( this occurs from pancreatic vein thrombosis followed by splenic vein thombosis then ultimately thru short gastric becomes visible gastric vessels)

Portal hypertension leads to torturous porto systemic anastomosis sites like lower esophagus & lower rectum. Isolated gastric vessels are unlikely in portal hypertension.

This case most likely acid peptic disorder from gastric ulceration where H pylori is the causative agent. However chronic alcoholism & cigarette both can cause gastric ulcer but cigarette is more common than alchohol in causing gastric ulcer.

So tobacco is the cause u exclude here 1st.

After you locate the gastric vessel and ulcer you need to take a biopsy of the ulcer to exclude H pylori & carcinoma in situ.

If h pylori is positive you need to start 3 drug regime.OME+AMOX+Clari

Hope it helps