Question

A 35-year-old female presents to your clinic with

complaints of onset of severe mid-epigastric pain and
vomiting following meals. Between meals she is asymptomatic. This has been going on for the past 2 years
ever since she purposefully lost 25 pounds to attain a
healthy weight for her height. Unfortunately, she has
continued to lose weight because of the postprandial
pain and vomiting. On her exam you notice a midepigastric
bruit.

The most likely diagnosis is:

A) Aortic aneurysm.
B) Atherosclerotic disease of the celiac trunk.
C) Superior mesenteric artery syndrome.
D) Chronic pancreatitis.

Answer 1

A 35-year-old woman with severe mid-epigastric pain and vomiting after meals likely has Superior mesenteric artery syndrome, suggested by the presence of a mid-epigastric bruit on examination.

Step-by-step explanation:

The 35-year-old female's symptoms of severe mid-epigastric pain and vomiting following meals, along with continued weight loss after a significant weight reduction, hint at a diagnosis that should include consideration of vascular causes. The key finding of a mid-epigastric bruit on examination suggests that there may be a vascular abnormality present. An aortic aneurysm could potentially cause these symptoms, but it is less likely to cause severe symptoms only after meals. The presents of symptoms following meals could also suggest a peptic ulcer or GERD, but these conditions typically do not cause a bruit. Chronic pancreatitis is often associated with chronic pain rather than pain only after meals, and the weight loss would be ongoing rather than postprandial. Considering the clinical presentation and the finding of a mid-epigastric bruit, the most likely diagnosis is Superior mesenteric artery syndrome (SMAS), which involves compression of the third part of the duodenum between the SMA and the aorta, leading to intermittent symptoms related to meal ingestion.