Dieulafoy Lesion MCQ — NEET PG Practice Question | NEETPGAI
Dieulafoy Lesion
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stethoscope Medicine
A 64-year-old man on aspirin presents with sudden hematemesis and hypotension (BP 82/48 mmHg). Upper endoscopy reveals a small (2–3 mm) raised pigmented protuberance on otherwise normal-appearing mucosa in the proximal stomach, with a spurting pinpoint artery and no surrounding ulceration or inflammation. The structure marked **B** in the diagram is identified and treated with epinephrine injection followed by hemoclip placement. Which of the following best describes the pathophysiological basis of bleeding in this lesion?
A. A dilated mucosal capillary network with telangiectatic patches that bleed from mucosal friability and venous stasis
B. A chronic inflammatory ulcer with a visible vessel at the base, typically associated with H. pylori or NSAID-induced mucosal damage
C. A caliber-persistent submucosal artery that fails to taper and exerts pulsatile pressure on overlying mucosa, eventually eroding through and rupturing
D. A longitudinal mucosal laceration at the gastroesophageal junction caused by forceful retching or vomiting
Explanation
Why option 1 is right
The structure marked B is a Dieulafoy lesion, which is histologically defined as a caliber-persistent submucosal artery (typically 1–3 mm in diameter, ten times the size of comparable submucosal arteries) that fails to taper as it courses through the bowel wall. This abnormally large artery exerts pulsatile pressure on the overlying mucosa, eventually producing a small focal erosion that exposes the arterial wall to luminal contents, leading to rupture and massive arterial bleeding. This is the defining pathophysiological mechanism (Dieulafoy PG 1898; ASGE Guidelines 2020).
Why each distractor is wrong
Option 2: This describes a peptic ulcer with a Forrest IIa visible vessel (structure C in the diagram), which is associated with chronic ulceration, inflammation, and typically H. pylori or NSAID use. Dieulafoy lesions have no surrounding ulceration or inflammation by definition.
Option 3: This describes angiodysplasia (structure D in the diagram), which presents as cherry-red telangiectatic patches with mucosal friability and venous stasis, not a caliber-persistent artery with a pinpoint erosion.
Option 4: This describes a Mallory-Weiss tear (structure A in the diagram), which is a longitudinal mucosal laceration at the gastroesophageal junction caused by forceful retching, not a submucosal arterial lesion.
High-YieldNEET PG
Dieulafoy lesion = abnormally large submucosal artery (1–3 mm) that fails to taper, erodes through normal mucosa, and causes sudden massive painless bleeding without surrounding ulceration.
Dieulafoy PG 1898; ASGE Guidelines on Non-variceal Upper GI Bleeding 2020
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