تصفح
دخول
تسجيل
نسيتها؟

non bloody diarrhea


non bloody diarrhea


حالة سريرية

الوصف الكامل Background
A 45-year-old white male comes to your office for evaluation of diarrhea of 8-months duration. He says that he has lost almost 15 lbs during the past 8 months. He denies any blood in the stools. 24-hour stool collection reveals fecal fat of 10 gm/day. Stool microscopy reveals no pathogens and no leucocytes. D-xylose test was performed which shows that less than 2 grams of D-xylose is excreted in urine in 5 hours. D-xylose test was re-performed after treatment with antibiotics but excretion is still less than 2 grams in 5 hours. Based on these findings, what is the most likely diagnosis in this patient?

A. Lactose intolerance
B. Bacterial overgrowth
C. Pancreatic insufficiency
D. Whipple’s disease
E. Terminal ileal disease

mbs2380's picture
by
بعد التخرج


حالة محيرة جداً ومو سهلة Sad

KMG's picture
KMG
طبيب مقيم


طيب سؤال :
هل يعتبر ويبل مرض شائع؟؟؟؟

mbs2380's picture
mbs2380
بعد التخرج


لاء هو نادر جدا جدا

a.m.a's picture
a.m.a
طبيب مقيم


علما أن ويبل نااادر، المفروض يكون في clue اله.
بالكابلان وقت بيحكوا عن أسواء الامتصاص بيقولوا whipple disease is the rarest

SINA's picture
SINA
طالب دراسات عليا


مرض نادر يصيب غالبا الذكور باواسط العمر

qusei


لا.. مرض نادر.

KMG's picture
KMG
طبيب مقيم


الحل هو ويبل. بس ليش؟!!

KMG's picture
KMG
طبيب مقيم


4 اجابات بنفس الوقت 23:47 Laughing out loud

qusei


weight loss is the most common presenting symptom

SINA's picture
SINA
طالب دراسات عليا

Quote:
الحل هو ويبل. بس ليش؟!!

على الأغلب لأنه ما في أعراض نقص K أو نقص امتصاص Ca....

Fouad's picture
Fouad
بعد التخرج


طيب اذا ويبل كيف التشخيص وشو الدواء ؟؟؟؟

qusei


هلق خلص طلع الجواب ويبل؟

the best's picture
the best
طالب دراسات عليا


التشخيص بالخزعة ..
والدواء يمكن TMP/SMX

SAMO's picture
SAMO
السنة الخامسة


التشخيص بالخزعة
الدواء باكتريم 6 أشهر أو سيفترياكسون يمكن

SINA's picture
SINA
طالب دراسات عليا

Quote:
طيب اذا ويبل كيف التشخيص وشو الدواء ؟؟؟؟

التشخيص بالخزعة....
العلاج بالصادات متل Trimethoprim-sulfamethoxazole , Penicillin G, أو Streptomycin لسنة أو سنتين....

Fouad's picture
Fouad
بعد التخرج


طولنا يا جماعة ....

qusei


اللي بعدوووووووو.....

Fouad's picture
Fouad
بعد التخرج


طيب سؤال ؟؟
ليش عطوا antibiotics ؟؟؟

mbs2380's picture
mbs2380
بعد التخرج


it is d
lets discuss the distractors one by one

xylose test result indicates a musocsal defect

so pancreatic insuf is out of question here

lactulose intolerance can cause some degree of malabsorption but not that much ( 10 grams of fat OMG) and it is usally associated with postbrandial bloating and cramps

bactecrial overgrowth would have responded to antibiotics

terminal ileal disease presents with fat malabsorption, right but xylose test will reveal normal; results as sugars are absorbed at an upper level

that leaves whipple's whic is the wastebasket of diagnosis
we diagnose it by a PAS+ve macropahge in a small bowel biposy and treat it with a tertarcylicne and aminoglycoide for 6-12 month
other sx include fever,arthritis,and nerological sx

Dr_Ayyad
بعد التخرج


وين بسام؟

dr.tabban's picture
dr.tabban


بكابلان: التشخيص بالخزعة منشوف ال organism وال
the single most sensitive test is PCR of the biopsy.

SINA's picture
SINA
طالب دراسات عليا


يعني الجواب هو ويبل .. بناء على نفي الآخرين؟!

SAMO's picture
SAMO
السنة الخامسة


مشان اذا في فرط تكاثر جرثومي

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
ليش عطوا antibiotics ؟؟؟

مشان ينفوا ال bacterial overgrowth يكون السبب بإيجابية اختبار ال D-xylose

SINA's picture
SINA
طالب دراسات عليا


شكراً د.هاشم....الله لا يحرمنا هالطلة.....

Fouad's picture
Fouad
بعد التخرج


قصدي منعطي الصادات مشان اذا في فرط تكاثر جرثومي

شكرا دكتور عيادي على التوضيح

يعني على ما يبدو تشخيص هالحالة بنفي الاسباب الاخرى

بانتظار الحالة القادمة دكتور بسام

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
it is d
lets discuss the distractors one by one

xylose test result indicates a musocsal defect

so pancreatic insuf is out of question here

lactulose intolerance can cause some degree of malabsorption but not that much ( 10 grams of fat OMG) and it is usally associated with postbrandial bloating and cramps

bactecrial overgrowth would have responded to antibiotics

terminal ileal disease presents with fat malabsorption, right but xylose test will reveal normal; results as sugars are absorbed at an upper level

that leaves whipple's whic is the wastebasket of diagnosis
we diagnose it by a PAS+ve macropahge in a small bowel biposy and treat it with a tertarcylicne and aminoglycoide for 6-12 month
other sx include fever,arthritis,and nerological sx

يعني شو بدي احكي ... Exclamation ما خلليت شي ينحكى Very Happy

dr.tabban's picture
dr.tabban


terminal ileal disease presents with fat malabsorption, - right but xylose test will reveal normal; results as sugars are absorbed at an upper level

oh, that makes sense

SINA's picture
SINA
طالب دراسات عليا

صح طولنا..
الجواب ويبل وهي الشرح...

Lactose intolerance may result in chronic diarrhea, but fecal fat will not be high in such causes (Option A).

Bacterial overgrowth, pancreatic insufficiency, Whipple’s and Crohn’s disease all result in chronic diarrhea with increased fecal fat content. D-xylose is a simple sugar. It does not need to undergo any digestive process before it can be absorbed. Its absorption requires an intact mucosa only.
In normal individuals, after ingestion of 25 grams of D-xylose, its urinary excretion will be greater than 4.5 grams in 5 hours. In pancreatic insufficiency, there is deficiency of pancreatic enzymes, which lead to impaired digestion of fats. D-xylose absorption remains unimpaired, as there is no damage to small intestinal mucosa.
In terminal ileal disease, bile salts are decreased due to impaired enterohepatic circulation, and as a result absorption of fats will be impaired. In bacterial overgrowth there will be both impaired fat absorption due to bacterial de-conjugation of bile salts as well as decreased excretion of xylose due to bacterial consumption of the simple sugar. In such cases, urinary excretion of xylose returns to normal after treatment with antibiotics. In the above case, urinary exertion of D-xylose does not increase after treatment with antibiotics and bacterial overgrowth is therefore ruled out. Whipple’s disease damages small intestinal mucosa, thus impairing D-xylose absorption (Option D).

Educational Objective:
D-xylose absorption is abnormal both in bacterial overgrowth and Whipple’s disease. However, with bacterial overgrowth, the test becomes normal after antibiotic treatment

mbs2380's picture
mbs2380
بعد التخرج

Quote:
يعني على ما يبدو تشخيص هالحالة بنفي الاسباب الاخرى
the best's picture
the best
طالب دراسات عليا
ابق على تواصل مع حكيم!
Google+