chronic diarrhea case scenarios.pdf

Casescenar io- 1 Ami ddleagedwomanpr esentstoamedi calgastr oenter ologistwit hcomplaintsof persi stentdiar rhoeasinc...

Casescenar io- 1 Ami ddleagedwomanpr esentstoamedi calgastr oenter ologistwit hcomplaintsof persi stentdiar rhoeasincethelast3mont hswhent hedoctorasksaboutanyot her complaintsshesay st hatov ert helastyearshehasbeenhav i ngmul ti plej ointpainsfor whichshehasbeenconsul t inganorthopedici anwhohasbeenwhohasbeent r eati ngher symptomat i call y.Heratt endersgivehistoryofthepati entforgett ingthi ngslatel y. Thegastroenter ologi stdecidestoper f orm anupperGIscopyandsi ncetheobtainedbiopsy samplestothepat hol ogylabandal sorequestsforaspecialstai ningtobedoneont he samples.Afterafewday st hepathologi stscallbackandsayt hatanOr gani sm Was detect edinthemucosaoft heintesti nalepit heli um andonf urt hermi cr obiol ogi cal examinati onwasal sof oundt obegr am posit iveandnonaci dfastandthespecialstai nthat theconsult anthadr equestedf or,theorgani sm testedposit iveforthesame. Q1.Whati stheOrganism inquest ion? Q2.Whati sthespecialstai nused? Q3.Whati sthediagnosisandhowwoul dy out reatt hispat ient ? Casescenar io2 52y earol dmal epr esentedt othehospi t al wi thcompl ai ntsofonandof fupperabdomi nal painwi t hv aryi ngi ntensi tysi ncethelast6mont hsthepati entalsosay sthattherehavebeen painf reeintervalsi nthelast6mont hshesay st hathisol dclothesdon' tf ithim anymoreand hav ebecomel oose. Nowt hepat ientpr esentswi thcompl aintsofdiarr hoeawi t hfoul smelli ngandbul kystools, onexami nationy ouf i ndt hatthepatienthashadanonuni tedrightradi al f ractur eandwhen enquir edHesay st hataver ynont r ivi al t raumal edtothatfr acture.Youalsonot i cethatthe patienthasmul ti pl ebrui sesal l overthebody. Investigati ons- Haemogl obin-10. 8 Tc–8300cel l s Platelets–3. 2l akhs PT–48. 2, I NR–3. 6 Trigly cer i des–312mg/ dl Calcium –7. 8mg/ dl RBS–286mg/ dL Q1.Whati stheprobablediagnosis? Q2.Whatar etheradiol ogicaldiagnosticmethodsyouwoul dli ketouseinthi spati ent? Q3.Whati stherol eoff aecalel ast aseevaluati onandwhatot herev aluat ionmethodswoul d youl iket oconsi der Q4.Howwouldyoutreatthispatient? Casescenario3 A36y earoldmalewi thoutanyknowncomor bi dit ieshascomef orusregul arbuyannual medicalcheckupandyouhaverevi ewedr epor tsandfoundthathehashaemogl obi nof9. 6 andhasanMCVof68per i pheralsmearsuchsuggesti veofmicrocyt ichypochromic anaemi a.Restoft her eportsappearnor mal andwheny ouaskt hepat ientregar dinghistor y ofanygast r ointest i nal bl eedhedeni essuchhi story Youaskt hepat ientforhi st oryofanyr epeat edbloodtransfusionssi ncethechildhoodwhich hedeni es.Butt hepat ienttell sy outhatsincet helastfewday shehasbeenhav ingonand offlooset ool swhi chhav ebeenf oulsmelli ngandf orwhichhewast akingsome medi cationsf rom al ocal Ayurvedicpracti ti oner.Thereisnowei ghtlossorappet i teloss theny oudeci det oev aluatethepat i entfortheanaemi aandf indt hat Serum f errit inisl ow Stool f oroccul tbloodi snegative,t histooldoesnotcont ai nanyov aororganisms. HBel ectrophor esi sisnor mal Youdi scusst hiscasewi thaseni orconsultantofy our swhoadv isestosendf oranti endomy sialant i bodi esandandtt i ssuetransglutaminaseant i bodi eswhi chcomeposi ti ve Q1.Whati sy ourdi agnosi s? Q2.Doest hedi agnosi sexplaintheirondeficiencyanaemi a,i fy est henhow? Q3.Woul dy ouadv iseanydi etarymodi f icati onsf orthi spat i ent ? Casescenar i o4 A34y earol dmal epresent stoy ouwi t hhistor yofdiarrhoeasi ncethelast4mont hsandal so giv eshi storythatshehasbeenpassi ngbloodinthestoolssincet hen,shesaysthatshehad consultedagener alsurgeonf ort hesameandhehadexami nedherandr uledoutanyl ocal causesf orthebl eedandhadr eferredthepati enttoyouf orfurthereval uati on. Ondet ail edhi storytakingt hepat i entrevealst hattherehasbeenal owgr adefeverthathas beenassoci atedsi ncet helastlast4mont hsandshesay sthatt hediarr hoeaisusuallyafter ameal orusual l yint heni ght. Youtakeupt hepat i entf orsi gmoi doscopywhichrevealsery t hematousandf ri ablemucosa withulcerati ons. Youaskf oraf ewi nvestigati ons HB-9.6 ESR-84mm perhour CRPel evated Fecalcalprotectin–posi ti ve Q1.Whati syourdiagnosis? Q2.Ift hepat i entalsohadpr esent edwi ththepi ctur eofobst ructi vej aundi cewhatwoul dbe yourdi fferent ialdi agnosis? Q3.Whatar etheneweragent sthatyouwoul dl i ketouseinthi spati ent ? Q4.Woul dyouscreenf oranymalignancies?