NBME 20 Annular pancreas (NBME Answers)

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nbme20/Block 2/Question#28 (reveal difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreas 🔍 / 📺 / 🌳 / 📖
tags: GI

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submitted by ∗monoloco(155)

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Annular pancreas is the only answer that accounts for the bile in the vomit; of the choices, it is the only obstruction distal to where bile enters the GI tract.

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ergogenic22 Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +

sympathetikey Correct. Might cause pain due to ectopic gastic tissue. +3

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submitted by gabriela(8)

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Also may help: Even though they are not DIRECTLY saying that there is difficulty feeding, the loss of weight indicates it in this case.

Causes of early feeding difficulties: + Annular pancreas + Tracheoesophageal fistula + Duodenal atresia

Causes of late feeding difficulties: + Congenital pyloric stenosis

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submitted by ∗draykid(31)

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I have a hard time understanding how annular pancreas can cause bilious vomiting when I'm seeing many sources say it is either bilious or non-bilious.

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draykid Ok, so after doing a little research. It can cause both, but if the annular pancreas wraps around the duodenum distal to the ampulla of Vater then you get bilious obstruction. +5

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submitted by ∗strugglebus(189)

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Also, Meckels would have describe hematochezia or failure to pass meconium

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sugaplum I believe failure to pass meconium is Hischsprung's Meckels don't present within the first few days of life, so meconium wouldn't be a factor FA 2019 378 +2

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