GI Pathology question!

[hunteradam07]

A 74 YO Male came into the office with the complains of epigastric pain 30-40min after eating, and pain doesn't relieve with antiacid tablet. Recently, he lost weight due to the fear of eating. His past medical history includes; Hyperlipidemia, Hypercholestolemia, and coronary bipass surgery. On his upper endoscopic exam all normal. The pathophysiology of the patient conditions closely relate to which of the following?
A. PUD.
B. Stable angina.
C. PE.
D. Crohn's disease.
E. Gastric CA.
F. Colon CA.

I am intersted in the why?

[Ella]

The ans is B

This pt has mesenteric ischemia (probably due to severe atherosclerosis). This means that the GI will not get adequate blood supply which can be very painful after meals since that is when the blood supply demand is the highest. Pts lose weight because the avoid eating due to the intensity of the pain.

This is the same patho-phys behind a stable angina. Due to narrowing of the lumen there is diminished blood supply to the heart. The pain increases when blood and oxygen demand increases.

[Seminole]

World world world lol

[hunteradam07]

Yep you guys got it rite. I wasnt so lucky. I got trick by the fact epigastic pain and not relieve via antiacids/weight lost due to fear of eating. According to Goljan's GI patho section that is classical s/sx of gastric ulcers (PUD). But So i pick that one . Even though i knew there is something to the fact that they gave hx of coronary heart disease. My logic was this guy must take NSAIDs for his heart problem, which decrease PGE increase s/sx of gastric ulcer via increase HCL production and decrese protection. I didnt think of chronic messentric ischemia. Oh, well dont make my mistake folks hahahs. I guess if they want NSAIDs abusive PUD, they would say something about it. Like Dr. ******* said dont make that leap hahaha! Live and learn .

[venureddy82]

i think we must take granted that all PUD will resolve with antacids, now we have only option that is angina.

[popolomania@yahoo.com]

This good thinking! The most important clues was the risk factors, not the presentation... beside one only said PUD... could be either gastric or duodenal...If I remember, Gastric is associated with weight loss, because of fear of eating, pain is worst with eating. In Duodenal pain is less with food, but worst 30-40 minutes after eating... kind of like the question.
Regarding PUD, I found a nice pneumonic for indications for surgery
I; Intractable pain( not relieved by meds)
H;hemorrhage( most common reason for massive GI bleedind in Adult)
O;Obstruction from scarring
P; perforation.

[madeeha khan]

also remember the upper endoscopy was normal which kind of rules out PUD and gastric ca.