إعلان
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لحظة من فضلك!
أهلا بكم
مشاريع 
هدية سألني فتى عن الحب فقلت له : انتظر !! الفعاليات القادمة
استطلاع الرأي إلى أي مدى تعتبر أنّ الدراسة النظريّة للطبّ في كليتنا ستخدمك سريرياً في المستقبل؟ أعتبر أنّ الفائدة معدومة في ظل النظام التدريسيّ الحالي. 28% الفائدة كبيرة جداً، وهي أساس التميز العملي. 6% الأمر نسبي، يختلف من طالب لآخر، ومن مادة لأخرى. 67% عدد الأصوات: 239 أهلاً بك ! تفضل الإبحار |
And we're back..نقاش الهضمية بجزءه الثاني
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بسم الله....
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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Laboratory Studies:
Hemoglobin 12.1 g/dL (121 g/L)
Leukocyte count 10,100/μL (10.1 × 109/L)
Serum aspartate aminotransferase 312 U/L
Serum alanine aminotransferase 468 U/L
Serum alkaline phosphatase 190 U/L
Serum total bilirubin 0.7 mg/dL (11.97 μmol/L)
Serum amylase 182 U/L
Abdominal ultrasonography shows several small gallstones. There is no gallbladder wall thickening or pericholecystic fluid, and no pain is elicited when the right upper abdominal quadrant is palpated with the ultrasound probe. The caliber of the common bile duct measures 7 mm (normal is less than 6 mm).
Which of the following is most likely causing this patient's pain?
A Acute pancreatitis
B Acute cholecystitis
C Choledocholithiasis
D Peptic ulcer disease
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اعتقد أن الجواب هو 3
وجود حصيات في اقنيات اصفراوية خاصة اذا كانت كبيرة الحجم يؤدي لحدوث التهاب الطرق الفراوية....
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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ok good, notice the typical presentation: patients with choledocholithiasis (common bile duct stones)typically have moderate to severe epigastric or right upper quadrant abdominal pain that is usually intermittent, inconsistently associated with nausea or vomiting, and occasionally nocturnal, and by the way, Symptomatic patients with choledocholithiasis almost always have elevated serum aminotransferase values.
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كأنو مافي غيرك فؤاد.. شو قصة العالم؟
WHERE ARE YOU PEOPLE!!!
يعني يهلك طول الليل وانا عم بنسخ وبكتب وبجي ما بلاقي حدا..
i will put the next case and then it will be over.
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i wanna add that the treatment is by removing the stones by ERCP.....also we remove the gallbladder to prevent a future occurrence of common bile duct obstruction.
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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Physical examination is normal. BMI is 21.
Laboratory Studies
Hemoglobin 9.8 g/dL (98 g/L) (was 13.5 g/dL [135 g/L] 1 year ago)
Leukocyte count 6500/μL (6.5 × 109/L)
Platelet count 250,000/μL (250 × 109/L)
Mean corpuscular volume 85 fL
Red cell distribution width 19 (normal: 11.5–14.5)
Serum ferritin 10 ng/mL (10 mg/L)
Serum albumin 4.5 g/dL (45 g/L)
Liver chemistry studies Normal
Serum thyroid-stimulating hormone Normal
Anti–tissue transglutaminase antibody assay Negative
Stool cultures No growth of pathogens
Stool examination for ova and parasites Negative
Stool assay for Clostridium difficile toxin Negative
Upper gastrointestinal series with small-bowel follow-through is normal. Colonoscopy with random biopsies is also normal.
Which of the following diagnostic studies should be scheduled next?
A Antiendomysial antibody assay
B Serum calcitonin measurement
C Upper endoscopy with small bowel biopsies
D Serum gastrin measurement
E Capsule endoscopy
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والله ما بعرف.....
كأنو ما حدا فاضي...الكل مشغول....
بركي هلأ بيدخل حدا تاني....
على كل الله يعطيك العافية.....
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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بعتقد الجواب هو 5
الحالة فقر دم مجهول السبب.....لذلك من الممكن أن تكون هناك نزوف في الأمعاء الدقيقة مسببة للنزوف....
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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she has thyroditis with hypothyrodism, she has wide distribution of red blodd cells "macro cells with micro cells combined result in normal MCV", think again.
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sorry....
but i can't catch it...
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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ok here's the thing: Celiac sprue is a primary consideration in this patient's differential diagnosis for several reasons. First, there is an association between celiac sprue and autoimmune disorders such as thyroiditis and subsequent hypothyroidism. Second, this patient has anemia with an increased red cell distribution width, suggesting a mix of erythrocytes with both microcytes and macrocytes (which together result in a normal mean corpuscular volume). Since malabsorption of both folate and iron occurs in patients with celiac sprue, folate deficiency could explain this patient's macrocytosis, and iron deficiency could cause the microcytosis. A serum anti–tissue transglutaminase (anti-tTG) antibody is an appropriate initial test for the evaluation of celiac sprue, but false-negative anti-tTG antibody results can occur in patients with this disease. some one told me that one explanation for a false-negative result is IgA deficiency, which may be present in 5% to 10% of patients with celiac sprue, also patients on a gluten-free diet will also have a false-negative anti-tTG antibody result. finally, a false-negative result may occur in patients with partial villous atrophy, so, if celiac sprue is suspected despite negative anti-tTG antibody results, upper endoscopy with small bowel biopsies is indicated to determine the presence of total or partial villous atrophy.
discussion is closed with a huge disappointment and anger.
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thank dr.mohannad
عقمت أم الزمان فلم تلد.......ولن تلد الأيام مثل محمد
Pic & Case
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Anti–tissue transglutaminase antibody assay Negative
If the pt had DH ( dermatitis herpitinifromis) will it be benefical if we try to measure the anti epidermail transglutaminase ( eTG ) or will it also be -ve
and regarding the choice a) EMA
why cant we go for that ?
as far as i know
endomysium , intestinal villi , and epidermal TG are being considered as foreign bodies to the host so why not try measuring all these first rather than taking a biopsy ?
or is it that the case didnt mention any DH or smooth muscle protein destruction
one last thing i read about celiac disease
is that its important to tell the pt that gluten can be present in other stuff such as stamp and envelope adhesive, medicines, and vitamins so they shud take care too
folate and iron
talking about vitamins
its very important to mention that not only Fe , vit B12 and folate are being malabsorbed but even the effect of vitamin k malabsorption
and here rises another confirmative test .. the PT ( prothrombin time )test --- prolonged
discussion is closed with a huge disappointment and anger.
if they're not participating that doesnt mean they're not reading and gaining knowledge
anyway
i dunno about rules around here so i apologize if am not allowed to write in a closed discussion
لأننا نتقن الصمت ، حملونا وزر النوايا ..
...
A goodbye isn't painful unless you're never going to say hello again.