Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

A 30-year-old woman with cystic fibrosis and pancreatic insufficiency presents with chronic cramping periumbilical pain, post-prandial bloating, early satiety, episodic bilious vomiting, pale and oily stools, and fluctuating weight, despite enzyme therapy. Imaging shows jejunal dilation and a retained patency capsule. What clinical factors should guide your choice of small bowel visualization strategies in the setting of suspected luminal narrowing? VIDEO INFO Category: Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Contraindications Case Type: Tricky Findings Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 30-year-old woman with cystic fibrosis complicated by pancreatic exocrine insufficiency and a prior episode of distal intestinal obstruction syndrome reports 6 months of cramping periumbilical pain that is worse after meals, post-prandial bloating, early satiety, episodic bilious emesis, and alternating pale stools and loose oily stools despite enzyme supplementation. Weight has fluctuated by 4 kg.... OPTIONS A. Proceeding today with ingestion of a small-bowel video capsule in the endoscopy unit under standard monitoring despite a retained patency capsule and a radiographic transition point, because suspected or known small-bowel obstruction is an absolute contraindication due to high capsule retention r... B. Deferring ingestion of the diagnostic capsule and first documenting clearance of a patency capsule (or its dissolution) on repeat imaging, then scheduling small-bowel capsule endoscopy electively if passage is confirmed, with cross-sectional re-imaging if symptoms worsen. C. Obtaining updated contrast enterography to map the transition precisely and then planning antegrade device-assisted enteroscopy in the endoscopy suite with therapeutic capability under deep sedation, if nonoperative management stabilizes the partial obstruction. D. Instituting supportive measures for partial obstruction-bowel rest, cautious fluids, electrolyte repletion, and symptomatic control-while avoiding capsule ingestion, then reassessing patency with noninvasive imaging before selecting enteroscopy or surgery. CORRECT ANSWER A. Proceeding today with ingestion of a small-bowel video capsule in the endoscopy unit under standard monitoring despite a retained patency capsule and a radiographic transition point, because suspected or known small-bowel obstruction is an absolute contraindication due to high capsule retention risk. EXPLANATION Proceeding today with ingestion of a small-bowel video capsule in the endoscopy unit under standard monitoring despite a retained patency capsule and a radiographic transition point, because suspected or known small-bowel obstruction is an absolute contraindication due to high capsule retention risk. This option is contraindicated because the patient has both imaging evidence of a discrete transition point with proximal jejunal dilation and serial radiographs showing a patency capsule still in the right lower quadrant at 24 and 30 hours. Those findings indicate impaired luminal patency. Proceeding with diagnostic capsule endoscopy in this setting carries a high risk that the capsule will lodge at the stricture, precipitating complete obstruction that could require urgent enteroscopy or surgery for retrieval.... --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this book to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this book as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------