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GI cases 1


GI cases 1


حالة سريرية

كتابة حرة وطرح موضوع النقاش!

بسم الله الرحمن الرحيم

السلام عليكم جميعا

بدأنا نقاش الهضمية الآن , سيتم تنزيل الحالة وننتظر بعدها 6 دقائق لإتاحة الفرصة للجواب والمناقشة وفي حال مضت ال6 دقائق ولم يجب أحد يقوم صاحب المسألة بتنزيل الجواب .
المهم -بما أن كل الحالات ستكون ضمن صفحة واحدة – عدم إدراج مسالة جديدة قبل الإجابة على المسألة السابقة .

Case 1
A 45 –year- old nurse practitioner presents to the emergency room for painful
abdominal pain and watery diarrhea.Patint report about 10 to 20 bowel movement aday .She also complains of nocturnal bowel movement .The patient has had multiple hospitalizations in the past for similar problems without a definit diagnosis .A lower GI endoscopy during a previous hospitalization showed a dark brown discoloration of the colon with lymph follicles shining through as pale patches.
What is the most likely diagnosis ?
a-factitious diarrhea
b-irritabe bowel syndrome
c-Celiac disease
d-infectios disease
e-non-hodgikne-lymphoma

a.m.a's picture
by
طبيب مقيم

factitious diarrhea
Quote:
a dark brown discoloration of the colon with lymph follicles shining through as pale patches

this is Melanosis Coli
she's a nurse so she has easy access to drugs including "laxatives"

SAMO's picture
SAMO
السنة الخامسة


ممكن مصطنع
بمتلازمة الامعاء الهيوجة لا اعراض ليلا

e و c
اسهال قليل بعدد المرات

qusei

Quote:
this is Melanosis Coli
she's a nurse so she has easy access to drugs including "laxatives

برافو SAMO

الجواب هو-factitious diarrhea

شوفوا الصورة يلي حطتها الدكتورة هبة

https://www.hakeem-sy.com/main/node/12387

Laxative abuse is caracterzide by watery diarrhea that is high in frequency and volume and is often associated with painful abdominal cramps .
Diarrhea is generally profuse with about with 10 -20 bowel movement a day and may be associated with nocturnal bowel movement ,which is not caracterstic of functional such as irritabe bowel syndrome

factitious diarrhea
is more frequently seen in women from high socioeconomic class and many of them are employeed in medical field .Such patient generally have history of multiple hospital admission in an effort to establish the cause of the diarrhea.

Melanosis coli typically occurs with the use of anthraquinone –containing laxative such as bisacodyl .It generally develops within four months of onset of laxative ingestion and cam disappear in same amount of time if laxative use is discontinued.
On endoscopy it is seen as a dark brown discoloration of the colon with lymph follicles shining through as pale patches.An alternative means of diagnosis is histlogical evidence of pigmention in the macrophage in the lamina propria.
Melanosis coli is not characterstic of Celiac disease, infectios disease or non-hodgikne-lymphoma

a.m.a's picture
a.m.a
طبيب مقيم


good case...thanx....
i was confused between a and e......
next?

Fouad's picture
Fouad
بعد التخرج


Irritabile bowel syndrome is less likely because of the nocturnal symptoms

In Celiac disease , we will see the signs & symptoms of malabsorption (e.g, weight lose ..)

Chronic infectuos diarrhea will be diagnosed easliy with stool exam ...

The other two choices - to be honest - aren't in my mind now , so I vote after samo to A

Johnnie Walker
بعد التخرج


A45- presents with complaint of difficlty awallowing both liquids and solids ,which was mild initially but has worsened gradually.He also complains of nocturnal cough .which disturbs his sleep as well as regurgitation of ungigeste food eaten several hours earlier .Physical examination is unreveling .Barim studies are performed which shows dilated esophagus ,loss of esophageal peristalsis ,and smooth tapering of the distal esophagus .What will be the most appropriate next step in management o this patient ?
a-Esophagocopy
b-Esophagial manometry
c-Esophagial PH monitoring
d-botulinum toxin ingestion
e-pneumatic dilation

a.m.a's picture
a.m.a
طبيب مقيم


I choose B ... diagnosis first

Johnnie Walker
بعد التخرج


i will chose e

Fouad's picture
Fouad
بعد التخرج

a-Esophagocopy
the case goes with Achalasia and the next step in approaching Achalasia (after Ba Swallow) is EGD to exclude secondary achalasia (which mimic the Hx, Diagnositic features and even manometric features of primary Achalasia)
SAMO's picture
SAMO
السنة الخامسة


تماما باريوم ثم قياس ضغوط المري

qusei


اللي بعرفه أنه قياس الضغوط هو أدق فحص.....بس مو دائماً بيستخدم.....بعتقد الأعراض والباريوم مشخصين....لهيك منبلش العلاج فوراً...

Fouad's picture
Fouad
بعد التخرج

Quote:
a-Esophagocopy
the case goes with Achalasia and the next step in approaching Achalasia (after Ba Swallow) is EGD to exclude secondary achalasia (which mimic the Hx, Diagnositic features and even manometric features of primary Achalasia)

perfect samo

الجواب هو a-Esophagocopy
When a motility disorder of esophagus is suggested by contrast studies,the next step is usually esophagoscopy to exclude mechanical causes of dysphagia like strictures or esophageal cancer .Esophagoscopy is then followed by manometry which is confirms the diagnosis .

Esophagial PH monitoring is done in some cases of gastroesophagial reflux disease and it is usually not indicated to evaluate dysphagia .

Botulinum ingestion is a treatment choice for achalasia in the elderly and those patients who can not tolerate more invasive procdures like pneumatic dilation or surgical myotomy .ل
But efore starting any treatment ,one must exclude other causes of dysphagia and diagnosis must be firmly established.
pneumatic dilation
Providesi symptomatic relief in mast patients and is a cost-effective procedure for treatment of achalasia

a.m.a's picture
a.m.a
طبيب مقيم


شو ايمتى نزل حالة ووين؟

moonberg's picture
moonberg
بعد التخرج

causes of Secondary (or Pseudo-) Achalasia are:
- Gastric (Cardia) Carcinoma
- Chagas Disease (Trypanosoma cruzi)
- Infiltrative diseases (e.g. Lymphoma)
SAMO's picture
SAMO
السنة الخامسة


يعني باختصار اللاارتخائية صورة ظليلة ثم تنظير ثم قياس الضغوط

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
شو ايمتى نزل حالة ووين؟

هون وهلاءEye-wink

a.m.a's picture
a.m.a
طبيب مقيم


تفضل د.عمار....

Fouad's picture
Fouad
بعد التخرج


غيرو شباب ولا بلش انا ؟

qusei


بانتظار الدكتور عمار ومن ثم الدكتور قصي (شكرا جزيلا لكما )

a.m.a's picture
a.m.a
طبيب مقيم


26. A 27-year-old woman comes to the physician because of a 2-year history of intermittent diarrhea and severe cramping abdominal pain. The stools are watery, occasionally foul-smelling, and nonbloody. She is currently pain-free and has not had diarrhea for 2 days. She also has intermittent constipation. She has not had fever or weight loss. She returned from a trip to Mexico 3 months ago. She had an appendectomy at the age of 12 years and a cesarean delivery 4 years ago. Examination shows no abnormalities. Which of the following is the most likely diagnosis?

A) Bacterial gastroenteritis

B) Crohn's disease

C) Intermittent small-bowel obstruction

D) Irritable bowel syndrome

E) Laxative abuse

moonberg's picture
moonberg
بعد التخرج


الجواب d

the best's picture
the best
طالب دراسات عليا


D is my choice

Johnnie Walker
بعد التخرج


Irritable bowel syndrome ؟؟؟

بما انو في اسهال وامساك بالقصة

a.m.a's picture
a.m.a
طبيب مقيم

B) Crohn's disease ?!?!
SAMO's picture
SAMO
السنة الخامسة


i will go with d

Fouad's picture
Fouad
بعد التخرج


c

qusei

Quote:
`بما انو في اسهال وامساك بالقصة

قبل ما قول صح ولا لاء شو بتفسري ال

Quote:
occasionally foul-smelling

؟؟

moonberg's picture
moonberg
بعد التخرج

to say IBS we have to exclude everything!! Don't we?
SAMO's picture
SAMO
السنة الخامسة


weel it might be c......coz of her past surgical history

Fouad's picture
Fouad
بعد التخرج


فرط تكاثر جرثومي حبايب ....لهيك نقيت C

qusei
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