Repeated Medical PG Question- 83

#SURGERY (AIIMS-PG)

Q- A 40-year old male presents with history of vomiting of blood 2 hours ago. The volume of vomitus was estimated to be 500 ml. His BP was 90/58 mm Hg and pulse was 110/min. On abdominal examination, the spleen was palpable 5 cm below the costal margin. The most likely cause of the bleeding is?

A. Portal hypertension

B. Gastric ulcer

C. Duodenal ulcer

D. Drug-induced mucosal erosion

Answer: A. Portal hypertension

▪️Splenomegaly and massive bleeding leading to hypotension and tachycardia in the patient are in favor of portal hypertension.

▪️Consequence of both increased portal vascular resistance and increased portal flow.

▪️Portal hypertension results in splenomegaly with enlarged, tortuous, and even aneurysmal splenic vessels. 

▪️Splenomegaly frequently is associated with hypersplenism, causing leukopenia, thrombocytopenia

Q- Diagnose the condition based on the sign marked by an arrow in the photograph below?

A. Stomach carcinoma.

B. Ileocaecal TB.

C. Ulcerative colitis.

D. Hypertrophic pyloric stenosis.

 

Correct Answer » D

▪️The gastrointestinal string sign (string sign of Kantour) refers to the string-like appearance of a contrast-filled bowel loop caused by severe narrowing of a bowel loop.

▪️Originally used to describe the reversible narrowing caused by spasms in Crohn disease, it is now used for any severe narrowing of the bowel lumen, including that seen in hypertrophic pyloric stenosis, gastrointestinal tuberculosis, carcinoid tumorand colon cancer.