ROSH Gastrointestinal Practice Exam

In cases of mistaken identity regarding gastrointestinal bleeding, what could be a possible misdiagnosis?

1. Cholecystitis

2. Pancreatitis

3. Esophageal varices

4. Peptic ulcer

The correct answer is: Esophageal varices

In the context of gastrointestinal bleeding, esophageal varices are an important condition to consider, especially in patients with liver cirrhosis or portal hypertension. They are dilated veins in the esophagus that can rupture and lead to significant upper gastrointestinal bleeding, often manifesting as hematemesis (vomiting blood) or melena (black, tarry stools). Misdiagnosis can occur when the symptoms of esophageal varices resemble those of other gastrointestinal disorders. In this scenario, the selection of esophageal varices as a possible misdiagnosis highlights the critical nature of distinguishing between various sources of bleeding in the gastrointestinal tract. For instance, the symptoms of variceal hemorrhage may be confused with those stemming from a peptic ulcer or other conditions that also present with similar bleeding symptoms. This makes accurate diagnosis essential for effective treatment. Factors that contribute to this misdiagnosis may include overlapping patient histories, concurrent liver disease, and failure to recognize the risk factors associated with portal hypertension. Each of the other conditions could present with gastrointestinal bleeding, but the specific anatomical and physiological contexts surrounding esophageal varices lend themselves particularly well to misdiagnosis when compared to analogous presentations from the other listed conditions. For example, cholecystitis primarily presents