(Question number 3)

A 63 yo women admitted to emergency department because of hematemesis for about 2 cups of

fresh blood. From her medical history known that she never has gastrointestinal disease before,
but she admit that she has hypertension and recently diagnosed as dyslipidemia. The angiography
showed the obstruction on the structure appointed.

a) What the most probably as the cause of hematemesis on this patient ? (Dx)
b) Which branch of appointed structure that involved in this case ?

(Question number 44)

A 66 yo severe obese women admitted to the emergency room caused by pain in the RUQ since
2 hours ago after she ate hamburger for lunch. From physical examination you reveal that there
is tenderness on RUQ, muscular defense on RUQ and murphy sign (+). Usg examination
showed inflamed gallbladder with gallstone on the structure appointed. After get the
diagnose, you consider to treat by surgical intervention as definitive therapy but there is
contraindication for cholecystectomy on the patient.

a) What the most probably surgical intervention that you choose for this patient?
b) If your treatment choice use the tool, where is port the entry for that tool ?

(Question number 45)

A 34-year-old man presents with substernal discomfort. The symptoms are worse after meals,
particularly a heavy evening meal, and are sometimes associated with hot/sour fluid in the back
of the throat and nocturnal awakening. The patient denies difficulty swallowing, pain on
swallowing, or weight loss. The endoscopic finding showed lesion in the area appointed and
known as Cameron lesion, and you prepare for surgical intervention.

a. What most probably cause for patient’s symptom? (…. Et causa ….)

b. to prevent the symptom recurrent, what the procedure you will do as a surgeon ?

(question number 46)

(The anatomical disorder showed on the preparat). From the x-ray imaging, you know that there
is a long gap between proximal and distal oesophagus. As a digestive surgeon what is the repair
procedure that you will choose?

Please choose 2 procedure !

(question number 47)

A 76-year-old white man presents with painless hematemesis and hypotension. He has no
previous GI symptoms but did have resection of structure appointed due to abnormality 12 years
previously. Emergency EGD shows no bleeding source in the stomach or duodenum.

a. diagnose ?

b. where is the bleeding source ?

(Question number 48)

A 4-week-old boy presents with a 10-day history of vomiting that has increased in frequency and
forcefulness. The vomitus is not bile stained. The child feeds avidly and looks well, but he has
been losing weight. An ultrasound of the abdomen is shown there is hypertrophy of the structure
appointed.

a. The first treatment for this case is conservative therapy, because many research show that
the condition is caused by abnormality of …. hormone, so it will be self limited.
b. If the hypertrophy still continuous, the definitive therapy for this condition is
pyloromyotomy using procedure named …