Small-bowel bleeding

  • Small-bowel bleeding Figure 1


A 75-year-old man presents with severe iron deficiency anemia. Single-balloon enteroscopy reveals a 12-mm reddish tumor in the third portion of the duodenum. What is true about this lesion?

This finding is very common in the small intestine. The layer of origin is the muscularis propria. The lesion is a congenital venous malformation. The lesion has malignant potential, and resection is always recommended, regardless of symptoms.
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Diarrheal disaster

A 52-year-old woman with a history of metastatic gastric cancer presents with gastric outlet obstruction. She undergoes EUS-guided gastrojejunostomy for relief. A month later, she is readmitted with abdominal pain, distension, and new-onset diarrhea. CT shows progression of disease with ascites. Paracentesis improves her abdominal pain, but her diarrhea persists. Upper endoscopy is performed. What is the cause of her diarrhea?
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Ubi pus, ibi evacua

Which of the following is true about acute cholecystitis diagnosis and management?
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The medical gaze

A 75-year-old woman presents with dyspeptic symptoms of new onset in the last 4 months. These symptoms persist despite self-treatment with over-the-counter low-dose proton pump inhibitors. She endorses that similar symptoms affected her remotely when she lived in Taiwan and resulted in a workup of a stool test before treatment with antibiotics. She underwent upper endoscopy. Which of the following statements is true?
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Divide and annex

A 64-year-old man presents with a 1-year history of dysphagia occurring intermittently before progressing to quotidian occurrence. Esophagram and subsequent EGD reveal a 5-cm Zenker’s diverticulum. He undergoes peroral endoscopic myotomy (Z-POEM) dividing the muscular septum and thus annexing the diverticular space into the esophageal lumen, which is uneventful. However, he returns in 1 month with recurrent dysphagia symptoms. Which of the following statements is true?
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Into the tunnel

A 50-year-old man is referred to the gastroenterology clinic for longstanding nausea and vomiting. He endorses a longstanding history of diabetes, which has only recently been well-controlled. The physical exam is unremarkable, and he denies weight loss.
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