ZSFG AM Report Pearls 1/26/18: The Hills Are Alive With the Sound of Abdominal Bruits

Thank you Yaanik for presenting the case of an elderly woman with post-prandial epigastric pain and weight loss. We discussed how thinking through physiologic changes around eating might help us narrow our differential and ultimately raised concern for mesenteric ischemia. The patient was also found to have an abdominal bruit…hence the title.


Physiologic Changes That Occur with Eating:

  • Gastrin secretion => Lower pH in stomach
  • Increased antral motility
  • Drop in pH of the duodenum
  • Pancreatic enzyme secretion
  • Gallbladder contraction
  • Increased blood flow to mesentery

Partial Differential Diagnosis for Abdominal Pain Worse with Eating:

  • Structural/Mechanical
    • H. pylori/PUD
    • Gastritis
    • Cholecystitis/Gallstone
    • Pancreatitis (acute vs. chronic)
    • Gastric outlet obstruction
  • Vascular
    • Mesenteric ischemia
    • Aneurysm
    • Compression of vessels (lymphoma or LN compression)
  • Malignancy
    • Gastric CA
    • HCC
    • Cholangiocarcinoma





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