Cases Flashcards
(2 cards)
A 41-year-old woman presents with an 8-month history of bloating and abdominal
discomfort, both relieved somewhat after a bowel movement of loose stools. She denies
nausea or vomiting. She has been prone to constipation most of her adult life and has a
history of dysmenorrhea, yet without menorrhagia. The patient reports no prior abdominal
surgeries, medications, or weight loss. Colonoscopy performed 1 year earlier was normal.
Findings on examination are normal.Her CBC revealed iron deficiency anaemia with
haemoglobin = 9.7 g/dl, mean corpuscular volume = 74 fL and s. ferritin= 7 μg/l. She was
advised to do gastroduodenoscopy.
A) What is the aim of the advised gastroduodenoscopy?
1-Iron Deficiency Anemia in Adults:
In the absence of obvious lower GI or gynecologic sources, upper GI sources must be ruled out.
Common causes: peptic ulcers, gastritis (e.g., from H. pylori or NSAIDs), celiac disease, or even upper GI malignancies.
2. Celiac Disease Suspicion:
Symptoms of bloating, loose stools, and iron deficiency anemia (without other causes) are classic for celiac disease.
Duodenal biopsy during EGD is essential to confirm diagnosis.
3. Rule out Gastric/duodenal lesions:
Including H. pylori-related gastritis, peptic ulcer disease, or less commonly, malignancy.
B) What are the other supportive investigations to reach the diagnosis?
1-Take duodenal biopsies: even if mucosa appears normal (to rule out celiac disease).
2. Test for H. pylori: via biopsy or rapid urease test.
3. Iron replacement therapy: oral or IV based on tolerance and severity.
4. If celiac is confirmed: start gluten-free diet and monitor response
A 70-year-old woman presents to the emergency department with dizziness and five episodes of bright red blood per rectum in the last 24 hours. Nasogastric tube lavage yielded bilious fluid without blood. The most common cause of severe hematochezia is Colonic angiodysplasia. B) Colorectal cancer. C) Diverticulosis. D) Ischemic colitis. E) Ulcerative colitis.
Diverticulosis
