GI Lab Questions Flashcards
A 60 year-old man complains of weight loss, diarrhea alternating with constipation. The patient is pale (anemic).
What tests would you perform?
1) Occult Blood Test
2) Ht - Tumer bleeding or factor consumpsion
3) Colonoscopy, Endoscopy and Irrigoscopy - Biopsy
4) GI Tumor Markers - CEA (Not specific) and CA19-9 (Colon/Pancreas) - After Surgry follow up
5) Imaging for Metastasis - MRI, CT, Xray
6) Depression could be a cause in elderly as well
A patient with chronic alcoholism, recurrent abdominal pain, meteorism, lost weight, stools are voluminous.
serum Ca: 2.1 mmol/l
PT - INR: 2.6; normalized after vitamin K administration
serum glucose (fasting): 12 mmol/l
ALP: 264 U/l
albumin: 40 g/l
Fecal elastase: decreased
Abdominal ultrasound: enlarged pancreas
What is your diagnosis? What other tests would you do?
- INR normalized after VitK given → Fat Dysgestion
- Meteorism → Dysgestion of Fat → Steatorehha
- Ca↓ →Vit D Dysabsorption
- Damage to Pancreas→ Insulin↓
- Ca↓→ALP↑, Mild so probable not Obstructive
- Normal Albumin → Not Acute Inflammation
- Fecal Elastase↓ → Exocrine Pancreatic Activity↓
- Enlarged pancreas + Alcohol→Chronic Pancreatitis
- ECRP → To rule out Pancreatic Cancer
A patient with intense periumbilical pain (Belt) of sudden onset, Low BP, Fast Pulse, Sweating and has Nausea. There is no defense on physical examination of the abdomen. Laboratory results:
ESR: 42 mm/h
WBC: 11 G/l
serum α-amylase: 1800 U/l
urine α-amylase: increased
serum lipase: increased
serum urea: 10 mmol/l
serum creatinine: 90 μmol/l
serum Ca: 1.9 mmol/l
serum albumin: 30 g/l
fasting blood glucose: 6.5 mmol/l.
What is your diagnosis? What other tests would you perform?
- ESR↑ (Fibrinogen causes RBC Roulex)+WBC↑ + Albumin↓ →Acute Inflammation
- Serum Urea Slightly Elevated → Impaired Kidney
- Check for Shock (BP↓,HR↑) with Shock Index
- Ca↓→ FA Saponification
- Fasting Glucose↑→ GNG↑ → Cortisol↑ (Stress)
- Urine α-Amylase↑+Seum Lipase↑ → Pancreatitis
- Further tests - Imaging Methods + LDH and CRP
- Treatment: Nil Per Os, Pain-Killers, Antibiotics
35 year-old with heartburn, occasional regurgitation of sour material in his mouth, mostly in the morning especially if leaning down. Provoked by drinking beer the evening before. Findings of an esophago-gastro-duodenoscopy: the proxymal part of the esophagus is
normal, but the distal part is hyperemic with erosions. The cardia is loose, the antrum is hyperemic in patches. The bulbus and the postbulbar duodenum is
normal. What is your diagnosis? What further test and treatment should be considered?
- GERD - Gastroesophageal Reflux Disease
- Causes: LES Insufficiency, Diaphragmatic Hernia, Acid over production, Obseity/Pregnancy.
- Further Tests : Esophageal Manometry, Gastroscopy with Biopsy with follow up Urea Breath test (H.Pyori)
- H.Pyori Treatment → Clarithromycin, Amoxicillin and PPI (Omeprazole).
- LifestyleChanges → AvoidCoffee/Alcohol/Spice and No eating before lying. No NSIAD
A 45 year old patient complains of maldigestion, increasing abdominal pain and weakness. Abdominal discomfort occurs shortly after meals or alcohol ingestion. Laboratory results:
Haemoccult+ and Anemia
What tests would you do, what are the treatment options?
- Haemoccult+ and Anemia→ Malignancy ?
- Pain Shortly after Alcohol→ Peptic Ulcer /IBD ?
- Test: (Malignancies/ Not) → Gastric Biopsy + Culturing for H. Pylori
- Test for H. Pylori → Urea Breath Test: Urease Function - Isotope CO2 Detection
- If Both Tests Negative → IBD (Question 6)
- H.Pyori Treatment → Clarithromycin, Amoxicillin and PPI (Omeprazole).
What tests would you perform if you suspect your patient has an autoimmune inflammatory bowel disease?
- For Inflammation → ESR & CRP
- rule out Neoplasm → Hemoccult & Colonoscopy
- rule out Infection →Culture & Microscopy
- Check with Biopsy & Serology:
- Celiac: Anti-Transglutaminase/Endomysium Abs
- Crohn’s: ASCA, UNcontinous & WHOLE thickness
- Ulcerative Colitis: p-ANCA & PSC, Continous & Superficail layers, Begins at Rectum.
A 30 year-old man complains of recurrent abdominal pain usually accompanied with diarrhea. These symptoms occur after the ingestion of fresh dairy products or alcohol.
What may be the cause of these complaints? What tests would you do?
- Lactose Intolerace worsend by Alcohol (Lactase↓)
- Lactose Hydrogen Breath Test - Check for H2↑
- Blood Glucose Test - Should have less after Lactose ingestion
- Stool Acidity Test (Infants) - pH below 5.5 means Lactose was fermented in colon.
- ESR and CRP for ruling out IBD
