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انسداد معوي (ألم بطني، وإقياء، وسويات سائلة غازية بالصورة الشعاعية) + نمشات في الفم ، ما هو التشخيص؟


انسداد معوي (ألم بطني، وإقياء، وسويات سائلة غازية بالصورة الشعاعية) + نمشات في الفم ، ما هو التشخيص؟

المعلومة

انسداد معوي (ألم بطني، وإقياء، وسويات سائلة غازية بالصورة الشعاعية) + نمشات في الفم ، ما هو التشخيص؟

المرجع

MEDSTUDY

DAM's picture
by


chron's

dr.tabban's picture
dr.tabban

Quote:
نمشات

تصبغات ميلانية

DAM's picture
DAM


اول شي medstudy كتاب تجاري مو مرجع
تاني شي هدا putz jagger
عاشر شي a the probable dx is intusuception w polyp acting as a leading point

Dr_Ayyad
بعد التخرج

Quote:
putz jagger

طبعا بوتز جيغرز ما بدها اتنين يحكو فيهاEye-wink

شكرا داااام بس خبرنا ليش بصير عند المريض انسداد أمعاء؟؟؟

لأنو بكون معو..........

وبعدين شو العلاج

moonberg's picture
moonberg
بعد التخرج

Quote:
لأنو بكون معو..........

بوليبات معوية

a.m.a's picture
a.m.a
طبيب مقيم


اشرحوا شوي يا شباب جزاكم الله خيرا

أبوليلى المهلهل's picture
أبوليلى المهلهل
بعد التخرج


اول شي medstudy كتاب تجاري مو مرجع

شو دكتور هاشم شو هاالإستنتاج الخطير Eye-wink Eye-wink Eye-wink
يعني الهاريسون مو تجاري ولا Uptodate كلوا بمصاري
medstudy
معلوماته موثوقة وكتاب مرتب مصمم أصلا لمراجعة الداخلية قبل امتحان البورد
أكيد مالح تفتح عليه إذا عم تدور على معلومة دقيقة لانو مختصر مو لانه فيه أخطاء

أتفق معك بالتشخيص

alfarok


خانة المرجع هي خانة إلزامية يجب على مدرج الدرة تعبئتها، وضعناها لكي تؤمن للقارئى معرفة مصدر المعلومة، والرجوع إليها في حال رغبته بالاستزادة او التأكد.
--------------------------
الجواب هو بوتز جيكرز.

المتلازمات البوليبية العائلية هي 4:
1- FAP : بوليبات غدية (بالمئات) في الكولون، احتمال التسرطن أكيد 100% (لازم نستأصل الكولون بعمر العشرين وقائياً).
2- Gardner: هي FAP + أورام نسج رخوة (ليبوما ...)، وآفات عظمية (osteoma)، فإذا لقينا واحد أورام عظمية لازم نعمله تنظير كولون، لنفي هذه المتلازمة، كما في الFAP التسرطن 100%.
3- peutz jeghers: بوليبات أمعاء دقيقة (Hamartoma بشكل أساسي، ولكن قد يوجد غدية=> لازال هناك احتمال تسرطن -أخف-)، ونمشات في الفم وعلى الشفة واللثة.
الشكل الأشيع لقدوم المريض هو: الانسداد المعوي (بالبوليبات)، أو الانغلاف المعوي.
4- Juvenile polyposis: شكل سليم.

DAM's picture
DAM


شكرا عالتذكرة Eye-wink Eye-wink Eye-wink

moonberg's picture
moonberg
بعد التخرج

Quote:
peutz jeghers: بوليبات أمعاء دقيقة

طبعاً ممكن تجي المعدة والكولون كمان.

في متلازمات ثانية مثل:
توركت: سرطان كولون مع سرطان CNS.
كودون .

DAM's picture
DAM

Quote:
peutz jeghers: بوليبات أمعاء دقيقة

طبعاً ممكن تجي المعدة والكولون كمان.

في متلازمات ثانية مثل:
توركت: سرطان كولون مع سرطان CNS.
كودون .

Quote:
شكرا عالتذكرة

أهلاً عزيزي، وشكراً على زيارتك.

DAM's picture
DAM


4- Juvenile polyposis: شكل سليم.

To my knowledge there is still risk of caner in this form of polyposis (unlike Juvenile polyp

MaKe the distinction between polyp and polyposis
see

1: Nat Clin Pract Gastroenterol Hepatol. 2007 Sep;4(9):492-502. Links
Hamartomatous polyposis syndromes.Zbuk KM, Eng C.
Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

The hamartomatous polyposis syndromes are a heterogeneous group of disorders that share an autosomal-dominant pattern of inheritance and are characterized by hamartomatous polyps of the gastrointestinal tract. These syndromes include juvenile polyposis syndrome, Peutz-Jeghers syndrome and the PTEN hamartoma tumor syndrome. The frequency and location of the polyps vary considerably among syndromes, as does the affected patient's predisposition to the development of gastrointestinal and other malignancies. Although the syndromes are uncommon, it is important for the clinician to recognize these disorders because they are associated with considerable morbidity and mortality, not only from malignancy but also from nonmalignant manifestations such as bleeding, intussusception, and bowel obstruction. Each hamartomatous polyposis syndrome has its own distinctive organ-specific manifestations and each requires a different surveillance strategy, which makes accurate diagnosis crucial for appropriate patient management. The availability of clinical genetic testing for these disorders means that appropriate recognition allows for timely referral for cancer genetic counseling, and often allows for predicative testing in at-risk family members. Promisingly, an understanding of the molecular pathogenesis of these disorders offers insights into the mechanisms underlying the development of sporadic malignancy, and enables rational selection of targeted therapies that warrant further investigation.

ABIM's picture
ABIM


THANX

qusei

Quote:
Juvenile polyposis:

To my knowledge there is still risk of caner in this form of polyposis (unlike Juvenile polyp

I found that also in Davidson and Harrison Manual !!!!

In Davidson, they asked for endoscopy and biopsy every 1-3 years.

In Harrison, they said : its is rare that JP develop cancer, and colectomy is controversial.

I got confused !!!!!

We'd better check it in UP TO DATE.

SALAMAT Eye-wink

helloyellow's picture
helloyellow
السنة الخامسة


one thing we can try to get out of is this complete surrender to names like harrison and davidson. look at the source, ie, studies that they report and qoute and then make up your mind with the patient .
for instance lets look up what the exact risk of malignancy and once we have this info we share it with the patient and see what they feel comfortable with.

ABIM's picture
ABIM

Quote:
Juvenile polyposis:

To my knowledge there is still risk of caner in this form of polyposis (unlike Juvenile polyp

I found that also in Davidson and Harrison Manual !!!!

In Davidson, they asked for endoscopy and biopsy every 1-3 years.

In Harrison, they said : its is rare that JP develop cancer, and colectomy is controversial.

I got confused !!!!!

We'd better check it in UP TO DATE.

SALAMAT Eye-wink

I used Medstudy as a source:
"This is the only one of these Syndromes with no malignant potentials. No follow up is needed"

In Kaplan lecture notes,they mentioned that it has 10% likely to develop malignancy.Rolling Eyes

DAM's picture
DAM


Let me ask DAM .Can you do a pubmed search for article on JPS and see what each one say about that risk.
Remember that such quick guide books are not designed to be deep and specific . Also the writer is frequenlty one for the whole session (one internist or gastroenterologist ) summerize the whole section and you know that even in one section (like GI) there are more specialized people to give better and more accurate statements

Finally and for Board purposes you JPS has a true malignant potenial

ABIM's picture
ABIM


I found this article in UPTODATE;

JUVENILE POLYPOSIS COLI AND FAMILIAL JUVENILE POLYPOSIS —

Isolated juvenile polyps (hamartomas) of the colon are common (occurring in 1 to 2 percent of children), usually solitary, and are not associated with an increased cancer risk (show histology 2).

In contrast, juvenile polyposis coli (JPC) is often defined as the occurrence of 10 or more juvenile polyps. Approximately one-third of cases of JPC have a history of similar lesions in at least one first degree relative, and are called familial juvenile polyposis (FJP).

FJP is a rare , autosomal dominant disease with high penetration. Germ-line mutations in a gene (SMAD4 also known as DPC4) located on chromosome 18q21.1, which encodes for a cytoplasmic mediator in the transforming growth factor-beta signaling pathway, have been identified as the causative mutation in some affected families [72,73]. The PTEN gene coding for a phosphatase and the BMPR1A gene coding for a serine threonine kinase receptor (both located on chromosome 10) have also been linked to FJP in some families [74]. The mechanism by which these mutations cause hamartomas is not understood, but genetic testing is now becoming available for these syndromes.

Children with FJP typically develop symptoms between the ages of 4 to 14 [75]. The disease usually presents with rectal bleeding and/or anemia (75 percent of cases). Less common presentations include rectal prolapse of polyps, abdominal pain, or intestinal obstruction.

FJP is associated with an increased risk for the development of colorectal cancer. Cancer is thought to arise from adenomatous change within the hamartomas, which has been found in approximately 8 to 47 percent of hamartomas from subjects with FJP. The risk of colon carcinoma in affected patients is unknown, but may be as high as 20 percent.

DAM's picture
DAM

Thank you

i could not get the opportunity to check it sine my U2D is still not working.

when i was reading Medstudy, and then checked harrison i was astonished by the conflict Shocked ..

thanks again

salamat Eye-wink

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helloyellow
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