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Case Presentation

Case Presentation. Mohammad Wazzan Ahmad Al Siari Supervised by : Dr. Hind Fallatah. History. 25 Years old not known to have any medical illness admitted to the hospital complaining of diarrhea, loss of weight and poor appetite for 2 months. + ve : flushing - ve : SOB, Fever, Jaundice.

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Case Presentation

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  1. Case Presentation Mohammad Wazzan Ahmad Al Siari Supervised by : Dr. Hind Fallatah

  2. History • 25 Years old not known to have any medical illness admitted to the hospital complaining of diarrhea, loss of weight and poor appetite for 2 months. • +ve : flushing • -ve : SOB, Fever, Jaundice

  3. Investigations • CBC : • Hg = 8 with low MCV and MCH • WBC = 4 • PLT = 200 • Creatinine = 220

  4. ASK MORE QUESTIONS ??

  5. Examination??

  6. Findings suggestive of IBD : • mouth ulcers, a skin rash, episcleritis, an anal fissure or fistula, the presence of visible or occult blood on digital examination, abdominal masses or abdominal pain • Evidence of malabsorption : • wasting, physical signs of anemia, scars indicating prior abdominal surgery • Lymphadenopathy • possibly suggesting HIV and TB infections • Abnormal anal sphincter pressure or reflexes • possibly suggesting fecal incontinence • Signs of hyperthyroidism: • Goiter, exophthalmos, lid retraction …etc.

  7. DDx ??

  8. Chronic Diarrhea Inflammatory Osmotic Gap • Infection • Bacterial • Parasitic • Viral Autoimmune High  Fecal Fat Normal • Secretory • Motility • +ve Malabsorption • Celiac • Wipple • Bacterial overgrowth • Tropical sprue • Pancreatic insufficiency • Others • -ve Osmotic • Lactose intolerance

  9. Osmotic Gap • Stool Osmotic Gap = 290 – [ 2 x (Na+K) ] • Less than 50 Normal

  10. IBS

  11. Thank YOU

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