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Gastroduodenal artery
21%
24/117
Left gastric artery
39%
46/117
Left gastroepiploic artery
9%
11/117
Proper hepatic artery
25%
29/117
Short gastric artery
2%
2/117
Select Answer to see Preferred Response
This patient with a history of gastric ulcers (abdominal pain associated with meals and melena) is presenting with severe abdominal pain (as well as rigidity and guarding suggesting perforation), hypotension, and free abdominal fluid. This is most consistent with a perforated gastric ulcer with massive bleeding, which is most likely the result of left gastric artery erosion. Peptic ulcer disease involves 1 or more ulcerative lesions in the stomach or duodenum. Gastric ulcers cause epigastric pain associated with meals, while the pain associated with duodenal ulcers improves with meals. Severe complications of peptic ulcers include perforation and bleeding. Perforated ulcers present with severe abdominal pain secondary to peritonitis and may be associated with bleeding if 1 of the abdominal vessels is involved. Gastric ulcers most commonly occur in the lesser curvature of the stomach and the antrum, and the left gastric artery is particularly susceptible to bleeding. Duodenal ulcers of the posterior wall are more likely to cause hemorrhage of the gastroduodenal artery. Peptic ulcer perforation and massive bleeding are treated with emergent surgery to repair the defect and control the hemorrhage. Incorrect Answers: Answer 1: Gastroduodenal artery bleeding is associated with perforation of duodenal ulcers located on the posterior wall. Duodenal ulcers cause epigastric pain that is relieved with meals (not worse with meals). Answer 3: Left gastroepiploic artery bleeding is not associated with perforated gastric ulcers. The left gastroepiploic artery supplies the greater curvature of the stomach. Gastric ulcers are less common in the greater curvature of the stomach due to the location and distribution of the acid-secreting parietal cells. Answer 4: Proper hepatic artery bleeding is not associated with perforated peptic ulcers. The proper hepatic artery supplies the liver and gallbladder after branching from the common hepatic artery and is located superolateral to the stomach. Answer 5: Short gastric artery bleeding is not associated with perforated peptic ulcers. The short gastric arteries supply the greater curvature of the stomach. Gastric ulcers are less common in the greater curvature of the stomach due to the location and distribution of the acid-secreting parietal cells. Bullet Summary: Perforated gastric ulcers are most common in the antrum and lesser curvature of the stomach and may cause bleeding of the left gastric artery.
3.7
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