GI Flashcards
A 29 year old women presents with fatigue, abdominal bloating and pain and loose stools for the past 3 months. She has also been suffering with recurrent aphthous ulcers in her mouth.
She opens her bowels between 2 and 4 times per day, and describes these stools as type 5/6, greasy and difficult to flush.
She has no past medical history and her only family history of note is that her brother has Type 1 Diabetes.
Coeliac Disease
A 53 year old woman presents to you feeling tired all the time and having significant muscle and joint aches over the last year. These symptoms have been getting progressively worse. She says she went through the menopause at aged 45, but have been having significant mood swings and memory problems in the last 6 months as well.
Examination reveals a bronze discolouration to her skin, but is otherwise unremarkable.
Haemochromatosis
First line investigation: serum Ferritin
A 24 year old lady presents to her GP with irregular bowel movements and crampy abdominal pain.
She normally opens her bowels between 1 and 3 times per day, and this can vary from normal to loose. Occasionally she has mucus in her stools, but denies any PR bleeding. She tends to get generalised crampy pain in her abdomen prior to opening her bowels, which tends to relieve the pain. These symptoms have not changed in the last year. She denies any weight loss or anorexia.
She only drinks limited alcohol on special occasions and does not smoke.
She is worried as her uncle was recently diagnosed with Crohns disease and she is worried that she may have the condition. She has no other family history.
Abdominal and PR examination are normal.
Routine blood tests come back normal.
What would be the most appropriate investigation for reassuring this patient? and if it’s negative what is the likely diagnosis?
Most appropriate investigation: Faecal calprotectin - a useful marker of intestinal inflammation that has a high negative predictive value for ruling out inflammatory bowel disease.
Irritable bowel syndrome
A 25-year-old white man presents to his general practitioner with cramping abdominal pain for 2 days. He reports having loose stools and losing 6.8 kg over a 3-month duration. He also reports increased fatigue. On physical examination, his temperature is 37.6°C (99.6°F). Other vital signs are within normal limits. Abdomen is soft with normal bowel sounds and moderate tenderness in the right lower quadrant, without guarding or rigidity. Rectal examination is normal and the stool is guaiac positive. The rest of the examination is unremarkable.
Crohn’s Disease
A 16-year-old girl presents to emergency care with perianal pain and discharge. She reports a 2-year history of intermittent bloody diarrhoea with nocturnal symptoms. On examination, she is apyrexial with normal vital signs. Her abdomen is soft and slightly tender on palpation in the left lower quadrant. Rectal examination is difficult to perform due to pain, but an area of erythematous swelling is visible close to the anal margin, discharging watery pus from its apex. Several anal tags are also present.
Crohn’s Disease
A 27-year-old man with a 3-month history of rectal bleeding and diarrhoea is referred for evaluation. Laboratory tests show mild anaemia, a slightly elevated erythrocyte sedimentation rate, and the presence of white blood cells in stool. Stool culture is negative. Colonoscopy shows continuous active inflammation with loss of vascular pattern and friability from the anal verge up to 35 cm, with a sharp cut-off. The colonic mucosa above 35 cm appears normal, as does the terminal ileum. Biopsy specimens show active chronic colitis.
Ulcerative colitis
A 46-year-old woman presents with fatigue and is found to have iron deficiency with anaemia. She has experienced intermittent episodes of mild diarrhoea for many years, previously diagnosed as irritable bowel syndrome and lactose intolerance. She has no current significant gastrointestinal symptoms such as diarrhoea, bloating, or abdominal pain. Examination reveals two oral aphthous ulcers and pallor. Abdominal examination is normal and results of faecal testing for occult blood are negative.
Coeliac disease
A 42-year-old man presents with a recent history of abdominal pain, distension, and nausea. Urea breath testing for Helicobacter pylori is positive.
Gastritis
A 42-year-old woman has heartburn after meals and a sour taste in her mouth. For the past 4-6 months she has had symptoms several times per week. Symptoms are worse when she lies down or bends over. Antacids help somewhat. She has no dysphagia, vomiting, abdominal pain, exertional symptoms, melaena, or weight loss. Past medical history and family history are non-contributory. The patient drinks alcohol occasionally and does not smoke. On physical examination, height is 1.63 m, weight 77.1 kg, and blood pressure 140/88 mmHg. The remainder of the examination is unremarkable.
Gastroesophageal reflux disease
A 40-year-old man presents to his primary care physician with a 2-month history of intermittent upper abdominal pain. He describes the pain as a dull, gnawing ache. The pain sometimes wakes him at night, is relieved by food and drinking milk, and is helped partially by famotidine. He had a similar but milder episode about 5 years ago, which was treated with omeprazole. Physical examination reveals a fit, apparently healthy man in no distress. The only abnormal finding is mild epigastric tenderness on palpation of the abdomen
Duodenal ulcer
A 48-year-old man presents to hospital after several episodes of vomiting blood following periods of forceful retching and vomiting. He has been binge drinking alcohol over the preceding 2 days.
Mallory-Weiss tear
A 64-year-old man presents to hospital after 4 episodes of vomiting over the past 2 days. He describes the appearance of the vomit as resembling coffee grounds. Black, tarry stool was seen during rectal examination; however, no other physical findings were seen
Mallory-Weiss tear
A 52-year-old man presents with a 6-month history of heartburn and atypical chest pain, both unrelated to food. He also described ‘gurgling’ sounds in his chest. A month before presentation he developed intermittent dysphagia to both solids and liquids, regurgitation, and weight loss of 3 kg.
Achalasia
A 22-year-old male presents to the emergency department with abdominal pain, anorexia, nausea, and low-grade fever. Pain started in the mid-abdominal region 6 hours ago and is now in the right lower quadrant of the abdomen. The pain was steady in nature and aggravated by coughing. Physical examination reveals a low-grade fever (38°C [100.5°F]), tenderness on palpation at right lower quadrant (McBurney’s sign), and leukocytosis (12 x 109/L or 12,000/microlitre) with 85% neutrophils.
Appendicitis
A 57-year-old woman with a history of hypertension and hypercholesterolaemia presents to the accident and emergency department with a 24-hour history of gradually worsening left-lower quadrant abdominal pain associated with nausea and vomiting. Prior to this episode, the patient did not have any significant gastrointestinal (GI) problems, except slight constipation and occasional dyspepsia after heavy meals. She felt feverish but did not take her temperature. Her family history is negative for GI disorders
Diverticular disease
A 53-year-old Asian man presents as an emergency patient with an acute onset of right lower abdominal pain of 3 days’ duration. He does not report any prodromal symptoms. On examination, he has a fever and right-sided abdominal tenderness lateral to McBurney’s point, and cough tenderness is positive.
Right sided diverticular disease
Right-sided diverticular disease is more common among the Asian population and specifically in younger people in Asia. Present with similar symptoms as acute appendicitis.
A 43-year-old female with a prior history of open cholecystectomy presents with gradual onset of nausea, vomiting, absolute constipation, abdominal distention and failure to pass any flatus or stool for 24 hours.
Bowel obstruction
A man in his early 70s presents with acute-onset, colicky, lower abdominal pain and distension, failing to pass flatus or faeces in the preceding 12 to 24 hours. He reports a recent change in his bowel habit with increased frequency of defecation, some weight loss, and the passage of blood mixed with his stools. On examination he is generally unwell, is pyrexial, and has a distended tympanic abdomen along the distribution of the large bowel, with tenderness in the right lower quadrant. He has an empty rectum on digital rectal examination
Large bowel obstruction
