crohn’s , diarrhea

1st day in git.

CASE 1: CROHN’S DISEASE

our case for today was a man of 50 y of age complaining of chronic diarrhea since 1 y 2 m .he complained of diarrhea at first, and then it was followed by diarrhea with streaks of blood and mucous, also diffuse abdominal pain. not related to eating. irrelevant family history. he had thyroid mass before and did an operation beforehand. also there was nocturnal diarrhea

dx: crohns disease.

ok what i want to ask if i had more time.analyse the abdominal pain. was there vomiting? did he suffer similar conditions before? how frequent did he defecate? consistency of stools? colour? was it fresh blood? any other complains?( think of the extraintestinal manifestations of IBD). effect of fasting( osmotic diarrhea stops but secretory diarrhea persists)?of course drug history is essential( think of antibiotics, laxatives, toxics) other associated diseases? diseases in other systems? ( DM- autonomic neuropathy, endocrinal- hyperthyroidism,) condition improved upon defecation? how severe was his diarrhea? acute chronic intmittent?hx of travel !!! alcohol? fhx! nocturnal diarrhea?(suggests organic disease

DDx diarrhea:
gastroenteritis ac
parasitic infestation( giardia lamblia)
IBS
IBD
CRC
gluten enteropathy
coeliac disease
drugs- antibiotics, laxatives, toxics
malabsorption!!!
autonomic neuropathy!!
SSc
hyperthyroidism!!!!

psst: think of other systems too!

mallory weiss syndrome: tear of the lower end of oesophagus , commonly due to retching.only involves the mucosa and submucosa unlike boerhaave syndrome which is transmural in nature.in this case there is rupture of the oesophagus.there is neuromuscular incoordination. most common site is leftposterolateral part of lower oesophagus. boerhaave synd. is likely to be more severe in presentation- expect shock. however diagnosis can be difficult.

prolonged diarrhea is an indication to perform endoscopy!

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