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Old 08-07-2012
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Question man with abdominal pain

A 55-year-old man comes to the emergency department complaining of abdominal pain He is well known to the emergency department staff, as he suffers from chronic pancreatitis and often seeks pain control after a bout of drinking Today, however he states that the pain is different. He reports that for the last couple of months he has had chronic, dull pain that is not as severe as his previous pain and is located more over his left upper quadrant. Previously, the pain was mainly umbilical. Vital signs are temperature 37.2C (99 0F). blood pressure 126/84 mm Hg. pulse 98/min. and respirations 16/min Physical examination of the skin shows no jaundice or spider angiomata. The abdomen is nontender. nondistended. and without caput medusae The spleen tip is palpable Laboratory studies show:


Hematocrit 32%
Leukocytes 7 000/mm 3
Mean corpuscle volume (MVC) 70
Platelets 490000/mm3


A chemistry panel and liver function tests are unchanged from the patient's baseline. On the basis of these findings, the patient undergoes an upper endoscopy that shows profound gastric varices but no evidence of esophageal varices Which of the following is the most likely diagnosis?

A. Bile duct obstruction
B. Cirrhosis
C. Hepatic vein thrombosis
D. Pancreatic pseudocyst
E. Splenic vein thrombosis
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Old 08-07-2012
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E. Splenic vein thrombosis
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E. Splenic vein thrombosis (caused by recurrent attacks of pancreatitis) leading to gastric varices due to development of collateral circulation via short gastric veins.
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Old 08-07-2012
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Thanks answer is correct..But Why this abdominal pain in splenic vein thrombosis...Usually varices present with bleeding..
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Old 08-07-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
Thanks answer is correct..But Why this abdominal pain in splenic vein thrombosis...Usually varices present with bleeding..
chronic, dull pain is typical of chronic pancreatitis
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