Question

A 56-year-old man comes to the physician complaining of early satiety, nausea, and vague epigastric pain for the past 4 months. He has a 36-pack-year smoking history and admits to drinking alcohol daily for the past 15 years. On physical examination, the patient appears thin and cachectic. Palpation of his abdomen reveals splenomegaly. Abdominal CT scan shows a large irregular mass extending posteriorly from the greater curvature of the stomach, impinging on the splenic artery and vein as they pass below. Tissues supplied by which of the following arteries would most likely be affected by compression of the splenic artery?

A. Gastroduodenal

B. Left gastroepiploic

C. Right gastric

D. Right gastroepiploic

E. Short gastric

Correct Answer: E. Short Gastric Artery
⚙️ Direct branches of the splenic artery; no collateral flow.
🧠 Key Insight: Vulnerable to ischemia.

Imaging: Mass compressing splenic artery/vein.
🧠 Key Insight: Look for downstream effects of vascular compression.

⚙️ Mechanism of Splenic Artery Compression
Mass at Greater Curvature
⬇️
Blocks Splenic Artery Flow
⬇️
🧠 Key Insight: "Think of the splenic artery as a tree trunk 🪵: Short gastric arteries are small branches, and they don't connect to other trees (no collateral)."

⬇️
Short Gastric Arteries (Fundus Blood Supply) Compromised
⬇️
⬇ Oxygen to Fundus
⬇️
Fundus Ischemia
⬇️
⚙️ Nausea + Early Satiety (Poor Fundus Motility)

⚙️ Mechanism of Splenic Vein Compression
Mass Blocks Splenic Vein
⬇️
↑ Venous Pressure in Spleen
⬇️
⚙️ Splenomegaly (Think of a dam 🛑 causing backup in a reservoir).

Cachexia (Weight Loss)
🧠 Key Insight: Likely due to chronic illness (malignancy), smoking, and alcohol use causing:
⬇
⬇ Food Intake (Nausea/Early Satiety)
⬇
⬇ Caloric Reserves

Explanation of Other Answers

Left Gastroepiploic Artery:
⚖️ "Backup system analogy": Has collateral flow from the right gastroepiploic artery.

Gastroduodenal Artery:
⚙️ Supplies duodenum and pancreas, not related to fundus blood flow.

Right Gastric Artery:
⚙️ Supplies lesser curvature, not the fundus.

Right Gastroepiploic Artery:
⚙️ Supplies greater curvature, not impacted by splenic artery compression.

Flashcards

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