Case 1

Case 1.
Female patient, 25 years old, has had watery diarrhea for 3 weeks, with intermittent fresh red blood in her
stools. Four days ago she developed fever; since then she has had more frequent diarrhea (seven to eight
times a day), which now consistently contains fresh red blood and mucus. She has vomited a few times;
her vomit has not been bloody or like coffee grounds. She has constant, cramping pain around her navel.
No history of illness, no medication.
On examination: female patient in a state of distress. Dry, scaly tongue, skin turgor decreased, symmetric
thorax, normal breathing sounds and bilateral chest excursion, heart rhythmic, clear cardiac sounds, no
murmur can be heard, HR: 96/min, RR: 100/75 mmHg, abdomen soft, palpable, no abnormal resistance,
no defense, but marked periumbilical tenderness, left side of abdomen and lower abdomen. Well palpable
peripheral vessels, no vascular murmurs can be heard.
Laboratory abnormalities to highlight: Hgb: 118g/l, Htk: 33%, RBC: 4 T/l, WBC: 11,9 G/l, BUN: 8.5
mmol/l, K: 3, 3mmol/l, CRP: 117,4 mg/l.
Fecal culture: no pathogenic bacteria have been cultured.
Abdominal ultrasound: the descending colon and the wall of the sigmoid colon are edematous, inflamed,
no free abdominal fluid.
Colonoscopy: moderate inflammation and a few small ulcers can be seen in the rectum, sigmoid and
descending colon.
Questions:
1. What could be the diagnosis of the patient? How can this be confirmed?
2. What are the most common causes of diarrhea? How can they be differentiated?
3. What to do with the patient?
4. What are the long-term complications of the disease? What extra-intestinal abnormalities may be
associated with it?
1
Case 2.
A 68-year-old male patient presents to the emergency department with weakness and dizziness. He says
that for 2 days his stools have changed color and he has been passing large amounts of very dark colored
stools. There was no vomiting, fresh red bloody stools, or bloody urine. History of smoking, IHD,
hypertension, hypercholesterolemia. His medications are atorvastatin 10mg 1tbl in the evening,
acetylsalicylic acid 100mg 1 tbl/day, ramipril 10mg 1 tbl/day and hydrochlorothiazide 25mg 1 tbl/day.
On examination: pale male patient, RR: 115/70 mmHg, HR: 102/min, symmetric thorax, normal breathing
sounds and bilateral chest excursion, heart rhythmic, clear cardiac sounds, no murmur can be heard,
abdomen soft, palpable, minimal epigastric tenderness, no abnormal resistance, no défense, normal bowel
sounds. On RDE (rectal digitalis examination) melena is found. Peripheral blood vessels are well palpable;
no vascular murmurs can be heard.
Laboratory findings: Hgb: 110 gr/l, Htk: 32%, RBC: 3,9T/l, MCV: 84 fl, PTL: 360 G/l, WBC: 9,8 G/l,
glucose (fasting): 6,2 mmol/l, BUN: 6,0 mmol/l, creatinine: 126 μmol/l, ALAT: 40 U/l, ASAT: 60 U/l,
ALP: 112U/l, GGT: 45 U/l, cholesterol: 6.0 mmol/l, HDL cholesterol: 0.7 mmol/l, triglycerides: 1.6
mmol/l, sodium: 145 mmol/l, potassium: 4,0 mmol/l. No abnormalities in urine.
Gastro-duodenoscopy: minimal fresh blood in the stomach, edematous mucosa of the bulbus duodeni,
superficial ulceration of about 1 cm in diameter on the anterior wall, with blood oozing from it. Biopsy
and hemostasis is performed (clip application, Tonogen injection).
Questions:
1. What could cause the lesion leading to melena?

2. What is the pathomechanism of peptic ulcer? What are the main triggers?
3. Why was a biopsy performed?
4. What are the main complications of ulcer disease?
5. Why was colonoscopy not the first choice?
6. What to do with the patient?
2
Case 3.
A 17-year-old girl visits her GP at the urging of her parents. Her mother is distressed by her significant
weight loss. The patient says that her mother is overreacting the situation; and she feels well, sleeps well,
although her mood is not the best and she has not had her period for several months. Her appetite has
decreased but she eats when she is hungry. She says she is not happy with her weight and would like to
lose a few more kilos. She has been dancing ballet for years and exercises several hours a day. She feels
that her relationship with her mother is strained and that she wants to control her in everything. On
physical examination, the patient is 173 cm tall and weighs 46.7 kg.
Questions:
1. What is the suspected disease?
2. What other diseases should be excluded in this patient?
3. What other physical and laboratory abnormalities might be present in this case and why?
4. What is the explanation for amenorrhea and what other complications can develop?
5. What treatment is recommended?

Case 1

Uploaded by

Copyright:

Available Formats

Case 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Case 1

Uploaded by

Copyright:

Available Formats

Case 1.

1. What could cause the lesion leading to melena?

You might also like