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NBME 22 Answers

nbme22/Block 4/Question#28

A 48-year-old man comes to the emergency department ...

Splenic vein

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Just a random factoid (as far as I know), in patients with pancreatitis the most likely vessel for thrombosis is the splenic vein due to close “anatomic ties” with the pancreas. This would also cause gastro-splenic varices, explaining the vomiting of blood.

meningitis  Also explains the splenomegaly. If you have thrombosed splenic vein, the blood will pool in the spleen, can also cause expansion of red pulp of spleen. +  

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submitted by aesalmon(38),

When in doubt its probably the Splenic Vein ("play odds" - Goljan)

Most common cause of splenic vein thrombosis is chronic pancreatitis, caused by perivenous inflammation.

Source: https://www.ncbi.nlm.nih.gov/pubmed/14502405

hyperfukus  great link! helps answer other qs too thank you :) +