Laboratory Diagnosis of GI Diseases Flashcards
(8 cards)
A 60 year-old man complains of weight loss, diarrhea alternating with
constipation. The patient is pale (anemic).
What tests would you perform
Clinical findings:
>weight loss at old age -> suspect malignancy
>Alternating diahorrhea and constipation -> typical for late stage colon cancer.
>anemia: due to chronic bleeding due to GI Tumour
Tests:
1) Haemoccult Test:
- check for occult blood in stool. feces smeared onto paper with glucuronic acid. H2O2 is added, if blood is present it becomes blood.
2) Feces DNA test
3) Colonscopy and biopsy
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?
clinical findings:
1) chronic alcoholism increases risk for chronic pancreatitis
2) Chronic pancreatitis also indicated by the reccurrent abdominal pain.
3) Weight loss: lack of digestive enzymes -> malabsorption
4) Voluminous stool that are difficult to flush suggest steatorrhea
5) enlarged pancrease due to inflammation but not sign of chronic pancreatis
Lab findings:
> decrease calcium (due to decrease uptake of vitamin D)
> INR longer but normalized after Vit K (because in chronic pancreatitis no lipase so absorption of Vit K)
>Fecal Elastase decreased -> inflammed pancreas
>Serum glucose is high as inflammation in pancreas causes secondary damage to Beta cells causes diahorrea)
Conclusion:
>chronic pancreatitis but cannot rule out pancreatic cancer.
Test:
>ERCP
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?
Clinical Findings:
>Periumbilical pain, low BP, Tachycardia -> maybe secondary manifestations of Acute Pancreatitis
IF LEFT UNTREATED BECAUSES SIRS (which explains symptoms)
Lab Findings:
>All indicative of shock.
>ESR + WBC elevated -> acute inflammation
>serum amylase increase -> indicates pancreatitis or stone in parotid duct
>Serum lipase: Indicates acute pancreatitis (not elevated in chronic)
>Serum Urea: Indicates failing kidney
>Serum creatinine: in higher range
>Serum calcium decreased (due to formation of insoluble soap)
>Serum glucose: due to failing pancreas not secreting enough insulin
DIAGNOSIS:
>Acute Pancreatitis
Tests:
- No need (amylase and lipase)
- can do US (see how bad by the size of pancreas)
Normal Parameters: Sedimentation Rate WBC SERUM AMYLASE SERUM LIPASE SERUM UREA SERUM CREATINE SERUM CALCIUM BLOOD GLUCOSE
Sedimentation: 20mm/H WBC: 4-10g/L Serum Amylase <180U/L Serum Lipase: in small amounts or not there Serum Urea: 3-7mM Serum Creatinine: 40-130 Serum Calcium: 2.2-2.6 Blood glucose: 2-6
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 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?
Clinical features:
- Heartburn
- Reflux of gastric acid
Diagnosis:
>GERD
Test:
Detect through nose, measure 24 Gastric Acidity
Treatment:
1) Don’t eat before bed/lie down
2) Eat Bananas as they neutrilize acidity
3) Anti-Acid Drugs (proton pump inhibitors)
4) Surgicial ligation around esophagus
5) Avoid Alcohol in evening
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?
Clinical Findings:
1) Maldigestion and Pain -> indicative of Peptic Ulcers
2) Positive Haemoccult -> suggest ulcer which can bleed
3) Anemia -> long term bleeding
Diagnosis:
>Peptic Ulcer
Tests:
>gastroscopy to look for peptic ulcer
>Test for H.pylori (endoscopy+ biopsy/ Urea breath test)
Treatment:
ABX
What tests would you perform if you suspect your patient has an autoimmune inflammatory bowel disease?
Symptoms of IBD:
1) fever
2) abdominal pain
3) diahorrhea
4) Weight loss
5) Blood in stool
Crohns Disease:
-affects areas in patches (esp terminal ileum)
Colitis Ulcerosa:
-do colonoscopy the whole setion from colon to rectum affected
Tests:
1) Inflammatory markers
2) contrast x-ray
3) colonoscopy w/ biopsy
4) Stool for occult bleeding
5) Video capsule endoscopy
6) auto ABs
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?
Diagnosis: LACTOSE INTOLERANCE
Further tests:
1) Gene Tests
2) Hydrogen breath test:
- > give them lactose and measure H2 of exhaled air, if increase then bacteria broke
**ALCOHOL INHIBITS REMAINING LACTASE
