A 4-Week-Old Boy Is Hospitalized with Persistent Vomiting, Fussiness, and Feeding

question 19

Multiple Choice

A 4-week-old boy is hospitalized with persistent vomiting, fussiness, and feeding intolerance.  The emesis was initially clear but became bilious in the last few hours.  The infant had been breastfeeding exclusively.  His temperature is 37.2 C (99.0 F) .  Blood pressure and pulse are normal.  Physical examination shows a normal abdomen with no rebound or guarding.  An upper gastrointestinal series is obtained urgently to evaluate for malrotation and volvulus and shows normal rotation but constriction of the duodenum.  An abdominal CT scan reveals pancreatic tissue encircling the duodenum.  Which of the following is the most likely cause of this patient's condition?

• A)Aberrant differentiation of the midgut structures
• B)Abnormal migration of the ventral pancreatic bud
• C)Ectopic rests not connected to the pancreas
• D)Failure of apoptosis in the dorsal pancreatic bud
• E)Failure of the ventral and dorsal pancreatic bud to fuse

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Definitions:

Mutual Misunderstanding

A situation in which all parties involved have a different understanding of the terms or conditions of an agreement.

Contract Executed

An agreement that has been fully performed by all parties involved.

Fraud

Intentional misleading to achieve unjust advantage or illegal benefit, or to cheat someone out of a lawful entitlement.

Executory Contract

A contract under which both parties to the agreement have outstanding obligations or performance yet to be completed.