SCENARIOS - gastrointestinal diseases.pptx

Revision of GI for undergraduate

1. case scenarios in internal Medicine MANSOURA-2019

2. Case1 : Sixty years old male presented to the ER by first attack of hematemsis , describes about 5 cups of dark clotted bloody vomitus . Mention 3 possible causes ? General examination : mention two physical signs to asses severity of the attack? Abdominal examination mention 2 signs of portal hypertension ?

3. Answer 1 1- Possible causes: - Rupture oesophageal varices . - Bleeding peptic ulcer. - Cancer stomach. 2- Signs of severity,,,, - Postural drop in blood pressure. - Postural increase in heart rate. 3- Abdominal signs of portal hyper tension : - Splenomegaly . - Visible dilated veins around the umbilicus with the direction of filling away from the umbilicus.

4. Case 2 A38 yrs old lady presented by recurrent attacks of vomiting in the last 3 monthes , abdominal ultrasound and upper endoscopy revealed no local causes , during examination you would like to examine : 1- The skin & mucus membranes for………………, to rule out………………………….. 2- The occular fundi for…………………….. to rule out……………………….

5. Answer 2 1- The skin & mucus membranes for dark pigmentation………………, to rule out …Addison disease. 2- The occular fundi for……… Papilloedema …………….. to rule out ……Brain tumor………………….

6. Case 6 A 52 yrs old lady presented by progressive constipation , in the last year with progressive loss of hair and gaining weight despite apparent decrease in appetite. 1- Three more symptoms you would like to ask ? 2- Expected abnormalities in vitals ( pulse & Bl.pressure ) ? 3- Two signs on neurologic examination ? 4- What do you expect on neck examination ? 5- Diagnostic test ?

7. Answer 6 1- Three more symptoms you would like to ask ? Sense of coldness - increase sleepness – poor concentration. 2- Expected abnormalities in vitals ( pulse & Bl.pressure ) ? Sinus Bradycardia - Hypertension. 3- Two signs on neurologic examination ? Delayed ankle reflex - Proximal muscle weakness. 4- What do you expect on neck examination ? May be diffuse thyroid enlargement . 5- Diagnostic test ? TSH , FT4 , FT3

8. Case 11 A 56 yrs old farmer , known to have chronic liver disease and diabetes , presented by diffuse abdominal enlargement and vague abdominal pain in the last 3 days . The wife reported fever 38.5 C last night. On exam: temp 37.9C , Bl pr 100/ 70 mmhg , Abdomen revealed diffuse enlargement , vague tenderness and positive shifting dullness. 1- Clinical impression ? 2- How to confirm your diagnosis ? 3- The diagnostic criteria ?

9. Answer 11 1- Clinical impression ? SBP = Spontaneous Bacterial Peritonitis . 2- How to confirm your diagnosis ? Diagnostic paracentesis . 3- The diagnostic criteria ? WBCS > 500/ ccc or Neutophils > 250/ ccc ascitic fluid.

10. Case 13 A 42 yrs old lady presented by recurrent Rt upper abdominal pain related to fatty meals . Last 48 hours pain became persistent with appearance of pale stool on examjnation there was icteric tinge , tender Rt hypochondrium . 1- What is your clinical diagnosis? 2- What is the initial imaging study ? 3- What did you expect the type of her increased bilirubin ?

11. Answer 13 1- What is your clinical diagnosis? Obstructive jaundice due to choledocolithiasis . 2- What is the initial imaging study ? Abdominal ultrasond . 3- What did you expect the type of her increased bilirubin ? Direct conjugated hyperbilirubinemia .

12. Case 14 A 56 yrs old male presented by disturbed conscious level, preceded by 2 days of black tarry stool , with past history of similar attack 9 month's ago they were told that it was an attack of hepatic encephalopathy : 1- Mention 3 other precipitating factors you would like to ask about ? 2- Five signs you will search on his limbs examination to confirm hepatic encephalopathy ?

13. Answer 14 1- Mention 3 other precipitating factors you would like to ask about ? - Heavy protein diet. - Repeated vomiting. - Vigorous diuretic use. 2- Five signs you will search on his limbs examination to confirm hepatic encephalopathy ? Oedema lower limbs. Spider naevi in upper limbs. Duptryn`s contracture in the hands. Palmar erythema of the hands. Terry nails ( white/pink nails )

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