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  #1  
Old 02-06-2013
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GIT GI problem

45 year old man presents to the physician with 3 month history of non – bloody, non – mucoid, non – oily watery diarrhea. He has a diastolic murmur that gets louder with inspiration and is best heard over the left lower sternal border. His face is warm and appears to be engorged with blood for several minutes during the examination. His laboratory studies show the following:
Vanillylmandelic acid: 4 mg/day
Metanephrine, urine: 200 μg/g of creatinine
Homovanillic acid, urine: 10 mg/day
5 – HIAA: 38 mg/day

Gastrointestinal endoscopy is most likely to show lesion located near which of the following?

A. Gastroesophageal junction
B. Ligament of Treitz
C. Pancreaticoduodenal junction
D. Rectosigmoid junction
E. Splenic flexure
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  #2  
Old 02-06-2013
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Default answer

i think its carcinoid syndrome........most common lesion is in appendix or ileum.....i will choose option d
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  #3  
Old 02-07-2013
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it's gotta be a place that escapes hepatic metabolism. Going with
A) Gastroesophageal junction
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  #4  
Old 02-07-2013
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i may be wrong, but i do believe its carcinoid syndrome.

carcinoids from the small bowel are most likely to be agressive/metastastize to the liver, and therefore produce his symptoms of:

diarhea
heart
flushing of the face

i would say somewhere near the ligament of triezt. (isn't this location the closest proximity to the small bowel?

B. Ligament of Treitz
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  #5  
Old 02-07-2013
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I didn't think about the hepatic metastases, I change my answer to
B) Ligament of Treitz
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  #6  
Old 02-08-2013
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answer is B-LIGAMENT OF TREITZ
carcinoid tumor-neuroendocrine tumor,malignant, metastatic if size>2cm.foregut and hingut carcinoid tumor invadive but rarely metastatic,midgut carcinoid tumors-invadive and metastatic. appendix is most common location,ussualy <2cm which is too small to metastasize to liver,terminal ileum metastasize to liver.tumor produce serotonin ,which are delivered to liver by portal vein.serotonin is metabolized to 5HIAA and excreted by urine(no go to systemic circulation).carcinoid syndrome-liver metastasis must to occur ,serotonin goes to systemic circulation-flushing,diarrhea,wheezing and dyspnea-due to bronchospasm,facial telangiectasia,tricuspid regurgitacion and pulmonary stenosis-serotonin increase collagen production in valves.increase urine 5HIAA.
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  #7  
Old 02-08-2013
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Correct Answer Correct answer is B.

Its Carcinoid Syndrome. 1/3 of Carcinoid tumors of GIT occurs in midgut derived small bowel; which begins at the Ligament of Treitz and ends at mid transverse colon.
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