A 42 yo woman is in clinic to discuss medical management for her obesity. Her BMI is 44 kg/M2. Sibutramine is one of the FDA-approved anti-obesity drugs. Which of the following combination of mechanism of action (MOA) and side effects (SE) is characteristic of this medication?
MOA: Serotonin and norepinephrine uptake inhibitor (SRNI)
A 50 yo woman is at the local restaurant for dinner. Her first plate of the evening is brought out to her. As she sees, smells, and thinks about tasting the food in front of her, acid begins to be secreted in her stomach. This initial phase of secretion is mediated by which of the following compounds?
A 68 yo man is being seen in clinic in follow-up of a non-healing pre-pyloric gastric ulcer that on four-quadrant biopsy has histological evidence of signet ring cells. Work-up for this pt’s condition should include which of the following?
A 60yo man comes to clinic w/ anorexia and wt loss associated with gnawing epigastric pain when eating for the past 2 months. Upper endoscopy reveals the presence of a 2.5cm Type III gastric ulcer. Rapid urease testing of a gastric tissue biopsy is negative. Four quadrant biopsy from the ulcer are negative for malignancy. He undergoes a 6 week course of therapy including cessation of ulcerogenic agents. Repeat endoscopy reveals the persistence of the type III ulcer with reduction in size to 2.3 cm. Repeat 4-quadrant biopsies are negative for malignancy. Which of the following therapies is most appropriate for this pt?
Antrectomy with truncal vagotomy
A 58 yo man presents to clinic for evaluation for wt loss surgery. His BMI is 36 kg/m2. On w/u, he is found to have poorly controlled DM and severe sleep apnea. In addition, he has stable angina, a recently discovered colon cancer, and a past history of alcohol abuse with cirrhosis but no portal HTN. Which of his comorbidities would be considered a potential contraindication for surgical intervention to assist w/ weight loss?
A 45 yo smoker presents to the ER w/ a 4 day hx of projectile vomiting. On PE he is HoTive and tachycardic. He has abdominal fullness, decreased skin turgor, and dry mucus membranes. Peristaltic waves visible in his epigastrium. Treatment for this disorder includes placement of a nasogastric tube and fluid resuscitation using:
A 68 yo woman presents to the general surgery clinic with a hx of epigastric pain and nausea w/o vomiting. The pain is burning, constant, and sometimes worse after meals. She underwent antrectomy w/ truncal vagotomy and Billroth I reconstruction for treatment of a non-healing pre-pyloric ulcer 6mo ago. She has mild epigastric tenderness otherwise her PE is normal. W/u includes an upper endoscopy, which reveals erythematous, friable stomach mucosa, a small ulcer near the gastroduodenal anastomasis, and a pool of bile in the dependent portion of the stomach. Mucosal bx reveal a corkscrew appearance of submucosal vessels. Rapid urease testing is negative. Which of the following drugs would be most helpful for this pt?
A 38 yo man presents to the ER complaining of abdominal pain, nausea, non-bilious vomiting, diarrhea, and palpitations. He recently underwent an antrectomy w/ billroth I reconstruction for a non-healing type I gastric ulcer. He reports that the symptoms began approximately 20mins after drinking his first milkshake since the operation. Which of the following drugs would be most helpful for this pt?
A 28 yo man presents to the ED w/ hematemesis. He reports a hx of chronic diarrhea and upper abd pain. He is not taking any medications. Endoscopy reveals the presence of both an anterior and posterior duodenal bulb ulcer. A gastrin level is elevated at 1200 pg/mL. Electrolytes are w/in normal limits except for an elevated calcium level of 11.3 mg/dL. Diagnostic imaging modalities are all negative for disease. After confirmatory testing, appropriate management for this patient would include:
A 38 yo woman is under going pre-operative counseling prior to undergoing Roux-en-Y gastric bypass surgery for morbid obesity. She has a history of type 2 DM and sleep apnea. Her BMI is 46 kg/M2. Without proper supplementation, what is the most likely nutritional deficiency to occur following her Roux-en-Y gastric bypass surgery?