Question of the Week # 464

464) A 68 year old man with history of Diabetes Mellitus type II and diabetic gastroparesis  is evaluated in your office for lack of appetite, nausea, vomiting, weight loss and a feeling full after eating small amounts of food material. He has lost 10 lbs weight in past 2 months. He denies any rectal bleeding or melena. He does report some epigastric discomfort. On examination, he appears in no distress, blood pressure is at 120/80. Abdomen is mildly distended with slight tenderness in upper abdomen. Patient is admitted and started on IV hydration. A plain X-ray abdomen is shown below. Gastroenterology is consulted and an upper endoscopy is pending. What is the most appropriate evidence-based next step?

gastric

A) Arrange for Laparoscopy
B) Endoscopic removal
C) Give Coca-Cola
D) Give Pepsi or any other soda
E) Metoclopramide

20 Responses

  1. E

    • what does the x-Ray show?

  2. E

    • Knowing what’s shown in this X-Ray will help you choose the correct answer. Diabetic gastroparesis is a distractor.

  3. A

  4. Give metochlropramide- pro kinetic

  5. Is it a volvulus? Laparoscopy?

    • Sorry I mean laparotomy ?

      • It’s a bezoar!!!!!

  6. It seems to have a weird foggy appearance. I feel like it’s a gastric bezoar and that it needs to be removed endoscopically. Taking a wild guess

    • Bezoar is correct but laparoscopy is not the first step!

      • Endoscopy

  7. give coca cola

  8. Is this because he was eating something weird or because the gastroparesis predisposed the accumulation of insoluble food stuff leading to the bezoar?

  9. Very interesting. Thank you for the links. For anyone trying to substantiate their coke intake, it does nt get better than this!! “Prescription coca cola” 🙂

  10. This is a good one . I did not know about coca cola and bezoar .Thank you

  11. so would have got this question wrong in the exam, seems like for some questions in step 3 take the most weird answer to get it right, i have never heard of a phyto gastric bezoar, what is it??

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