Labs: Gastrointestinal Diseases Flashcards
A 60 year-old man complains of weight loss, diarrhea alternating with constipation. The patient is pale (anemic). What tests would you perform?
Weight loss, diarrhea, anemia: test for GI malignancies
Hemoccult tests: Guaiac, Weber. Can become anemic from occult bleeding.
GI Tumor Markers: CEA, M2PK, CA 19-9 (carb antigen)
Main diagnostic tools: Endoscopy, colonoscopy Other imaging (MRI, CT)
A patient with symptoms of chronic alcoholism complains of recurrent abdominal pain, meteorism. He has lost weight in the past few months, his stools are voluminous, difficult to flush.
serum Ca: 2.1 mmol/l
prothrombin time 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?
Pancreatitis, prob chronic pancreatitis from alcoholism. Measure panc enzymes like amylase, lipase in blood. Need to rule out pancreatic cancer by performing ERCP (endoscopic retrograde cholecysto-pancreatography) and CA-19-9 tumor marker
Numerous signs of poor fat digestion like steatorrhea
INR high (>1.2) due to poor fat digestion and poor vitK uptake
Ca2+ low due to pancreatic fat necrosis FFA precipitating with Calcium
BGL high (>6 mM) due to loss of pancreas function to secrete insulin
ALP only mildly high (>150) excludes bile stone possibility (would be very high)
Low elastase due to poor panc function too.
Albumin normal (35-50) indicates inflammation not acute.
A patient complains of intense periumbilical pain of sudden onset. His blood pressure is low, the pulse is fast, he is 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?
Acute (Necrohemorrhagic form) Pancreatitis: belt-like pain, high ESR, low albumin, high serum and urine pancreatic enzymes, circulatory shock signs (low BP, symp activation). Have enough info already but can do imaging: see swollen pancreas, check exocrine/endocrine function after acute period is over.
Urea borderline elevation: shock reduces blood supply to kidney
Calcium is low due to Calcium-FFA formation via self-digestion
Albumin low bc it’s a negative acute phase protein
A 35 year-old man complains of heartburn and occasional regurgitation of sour material in his mouth, mostly in the morning especially if leaning down. These symptoms were provoked by drinking beer the evening before. Findings of an esophago-gastro-duodenoscopy: the proximal 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.
Antrum hyperemic patches are indicative of duodenal-gastric reflux or could be H. pylori in antrum.
Test H. pylori status (urea breath test) and can do eradication therapy: triple therapy (clarithromycin, amoxicillin, and PPI)
Also avoid eating/drinking before lying down. Avoid alcohol, coffee, and spicy foods.
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: +
anemia
What tests would you do, what are the treatment options?
Occult bleeding: normally tumor suspected, but this person is young. Maldigestion and abd pain also not really part of cancer.
Ulceration a more likely cause: bleeding due to ulcers in upper GI or IBD. Do endoscopy, video capsule endoscopy or virtual endoscopy with CT, colonoscopy, urea breath test.
Treatments: PPIs, if H. pylori add ATBs too. If IBD, doesn’t have many therapies - maybe immunosuppression (steroids). New IBD drugs target Th1 cytokines.
What tests would you perform if you suspect your patient has an autoimmune inflammatory bowel disease?
Most important: imaging and stool examinations
Imaging: colonoscopy, distal endoscopy, capsule endoscopy
Stool: hemoccult, rule out microbe/helminths
Systemic markers: CRP, autoimmune antibodies
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 Intolerance
Does not actually need a test other than seeing if symptoms go away after quitting milk products. However, you can prove intolerance by having pt drink lactose and check their breath for increases in H2 gas from lactose-fermenting bacteria.
