Question of the Week # 375

375)  A 65 year old woman is evaluated in your office for weight-loss of 20lbs over the past 6 months. She thinks she has lost weight because she is scared of eating since food causes her to have significant abdominal pain. Pain is particularly worse when she takes a fatty meal and is associated with nausea and early satiety. She has a history of coronary artery disease for which she underwent percutaneous coronary intervention 2 years ago.  She denies any chest pain, palpitations or irregular heart beat. She smoked 1 pack cigarettes per day for the past 40 years. On examination, her vitals are stable. Cardiac and abdominal examination are benign. Stool occult blood is negative. Which of the following is the most likely etiology of her symptoms?

A) Mesenteric vein thrombosis

B) Mesenteric atherosclerosis

C) Gastric Malignancy

D) Cholelithiasis

E) Mesenteric arterial thrombosis

13 Responses

  1. B) Mesenteric atherosclerosis??

  2. D)Cholelithiasis

  3. B. Mesentric atherosclerosis

  4. D)Cholelithiasis

  5. D

  6. B) Mesenteric atherosclerosis;

    cholelithiasis though has a similar history question will give you young obese female but here an elderly with CAD points towards atherosclerotic disease in other vessels;

    why not Mesenteric artery thrombosis ? because thrombosis/embolus presents as an acute event but here pt describes a chronic event

    for vein thrombosis risk factors are completely different like pregnancy hypercoagulability malignancy prtal hypertension etc…

  7. E the pt need more blood if she eat but with the arterial problem it is not happening normal and the pain comes them is a chronic mesenteric ischemia

  8. D/ Cholelitiasis

  9. Mesenteric atherosclerosis

  10. B) mesenteric atherosclerosis

  11. B

  12. B: severe pain after meal and abdomen is benign. she has ho CAD. chronic heavy smoker. and chronic symptoms and weight loss. most probably Mesentric athesclerosis.

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