Question 156

Question:

A 52-year-old male presents with severe epigastric pain and episodes of vomiting blood. The pain is usually relieved by consumption of food or Antacids. The patient’s history is significant for prior episodes of epigastric pain for which he receives triple therapy. Which of the following vessels is most likely implicated in the patient’s current complaints?

Correct Answer: B.  Gastroduodenal artery

This patient has a past medical history, medication history, and presentation consistent with a bleeding peptic ulcer. He is receiving triple therapy, which indicates that it is suspected his ulcer is related to H. pylori infection. The majority of H. pylori-related ulcers occur in the first or second segment of the duodenum, with the remainder more common in the antrum of the stomach.
Thus, the most likely location of the ulcer is in the duodenum. The gastroduodenal artery, a branch of the common hepatic, courses around the first segment of the duodenum, and is thus the most likely bleeding vessel.
Both the left gastric and left gastroepiploic arteries course along the stomach and may explain the bleeding, but are less likely than a duodenal ulcer.
The portal vein or one of its tributaries may cause bleeding or hematemesis in patients with venous congestion (e.g. cirrhosis, alcoholism); we don’t suspect that in this patient.
The azygous vein is retroperitoneal and is extremely unlikely to be causing this patient’s GI symptoms in the absence of major trauma.