A 40-year-old woman with alcoholic cirrhosis presents with worsening confusion and ascites. On examination, she has mild jaundice, a temperature of 37.5°C, and a flapping tremor of the outstretched hands. Abdominal examination reveals tense ascites. Her lab results show mild leucocytosis, elevated bilirubin, AST, and alkaline phosphatase, and a polymorphonuclear cell count of 350 cells per mm3 in the ascitic tap. What is the most appropriate treatment for this patient?
A 49-year-old construction worker arrives at the Emergency department via ambulance. He is accompanied by his girlfriend. He has a history of cirrhosis and continues to consume three beers per day and a glass of whiskey at night.
In the past few hours, he has become increasingly disoriented, complains of abdominal pain, and has vomited twice. He has a fever of 38.1°C, his blood pressure is 100/60 mmHg, his pulse is 90 and regular. There are indications of chronic liver disease, and his abdomen is tender throughout with noticeable ascites. Bowel sounds are present.
The following tests were conducted:
– Hb 102 g/L (135-180)
– WCC 13.2 ×109/L (4-10)
– PLT 109 ×109/L (130-400)
– Na 134 mmol/L (135-145)
– K 4.9 mmol/L (3.5-5.5)
– Cr 128 µmol/L (70-120)
– Urea 7.1 mmol/L (2.5-8)
– Albumin 22 g/L (35-50)
What is the most probable cause of his presentation?
A 35-year-old construction worker who has been working in a dusty environment presents to the clinic for review. e has been feeling increasingly unwell over the past 3 months with abdominal pain, bloating, heartburn and intermittent diarrhoea. He also has a dry cough and shortness of breath, and a recurrent rash affecting his thighs and buttocks. The local medical practitioner gave him a salbutamol inhaler, but this had little effect on his symptoms. On examination his BP is 120/80 mmHg; pulse is 80/min and regular. He has scattered wheeze on auscultation of the chest and heart sounds are normal. His skin is dry and there is an erythematous rash over buttocks.
Investigations;
Hb 130 g/l
WCC 8.5 x109/l
Eosinophils 1.8 x109/l
PLT 250 x109/l
Na+ 140 mmol/l
K+ 4.2 mmol/l
Creatinine 90 micromol/l
CXR Diffuse pulmonary infiltrates
Stool sample No significant abnormality identified
What is the most appropriate next investigation?
A pedunculated polyp is removed during colonoscopy and found to have invasive adenocarcinoma. At the interdisciplinary meeting, the pathologist reports that the carcinoma has invaded the neck of the polyp. What is the stage of the polyp cancer described?
A 55-year-old woman has been diagnosed with a gastrinoma in her pancreas. Fortunately, there are no signs of metastases. What is the initial preferred treatment option?
A 35-year-old teacher presented to the outpatient clinic with a complaint of chronic diarrhoea for the past six months. The patient reported bloody stools with at least ten bowel movements per day, often occurring at night. There was no recent travel history. The patient reported high levels of stress at work due to meeting academic targets. The patient also reported irregular eating habits, often consuming convenience foods. The patient’s sister had a history of bowel complaints that improved after eliminating bread from her diet.
On examination, the patient appeared tired and pale. The patient’s temperature was 37.9°C, blood pressure was 139/67 mmHg, and pulse was 90 beats per minute. Abdominal examination was normal except for bloody stool on the glove after per rectal examination.
The following laboratory results were obtained: haemoglobin 107 g/L (130-180), white blood cell 13.2 ×109/L (4-11), platelets 160 ×109/L (150-400), serum sodium 143 mmol/L (137-144), serum potassium 4.0 mmol/L (3.5-4.9), serum urea 4.0 mmol/L (2.5-7.5), serum creatinine 100 µmol/L (60-110), plasma glucose 5.1 mmol/L (3.0-6.0), serum albumin 35 g/L (37-49), serum AST 22 U/L (1-31), serum alkaline phosphatase 100 U/L (45-105), and serum C reactive protein 110 mg/L (<10). What diagnostic test would be most appropriate to determine the cause of the patient’s symptoms?
A 32-year-old woman with a history of multiple small bowel resections presents with chronic diarrhoea and difficulty maintaining weight. She has a healed laparotomy scar on her abdomen and was unsuccessfully weaned off total parenteral nutrition. On examination, her BMI is 19 and her blood pressure is 103/80 mmHg with a pulse of 80 bpm. Her lab results show low haemoglobin, albumin, and potassium levels, as well as elevated C-reactive protein. What is the most effective next intervention for this patient?
A 43-year-old woman has been referred for investigation of persistent iron deficiency anaemia despite taking oral iron supplements. She has a medical history of menorrhagia, depression, and gastro-oesophageal reflux disease.
Her current medications include ferrous fumarate, tranexamic acid, sertraline, and amitriptyline. Additionally, she occasionally takes over-the-counter paracetamol, ibuprofen, and an antacid solution.
Despite normal endoscopy and imaging results, recent blood tests confirm ongoing iron deficiency anaemia. What could be the possible cause for her persistent iron deficiency?
A 38-year-old woman presents to the emergency department feeling generally unwell. She has been experiencing a productive cough, worsening abdominal swelling, and severe constipation for the past five days. Her friend who is with her has noticed that she has been increasingly confused and mentions that she has a history of extensive alcohol use. The patient has a medical history of cirrhosis and COPD, but cannot recall the names of her medications, except for a red inhaler that she uses regularly.
Upon examination, the patient appears jaundiced, feels hot and clammy, and has crepitations in the left lower lobe. Her abdomen is distended with evidence of ascites, and she has distended veins on her chest.
Observations:
– Saturations: 93%
– Respiratory rate: 18/min
– Blood pressure: 121/58 mmHg
– Heart rate: 109/min
– Temperature: 38.2°C
Blood tests reveal:
– Hb: 121 g/l
– Platelets: 52 * 109/l
– WBC: 16 * 109/l
– Na+: 147 mmol/l
– K+: 4.8 mmol/l
– Urea: 11.1 mmol/l
– Creatinine: 153 µmol/l
– Bilirubin: 57 µmol/l
– ALP: 173 u/l
– ALT: 121 u/l
– Albumin: 26 g/l
– INR: 2.3
– PT: 25s
Further tests are ordered, including a CXR that shows left lower lobe consolidation, blood cultures, and an ultrasound scan of her abdomen. Additionally, calcium, phosphate, magnesium, and glucose levels are checked. In the acute setting, what other investigation would be most appropriate?
A 50-year-old woman presents to gastroenterology with a six-month history of chronic diarrhoea, bloating, flatulence, and occasional abdominal pain. She has a medical history of limited systemic sclerosis but takes no regular medications and has not recently used antibiotics. On examination, she has mild skin thickening on her hands, and her abdominal exam is unremarkable. Her lab results show a hemoglobin level of 122 g/L, platelets of 189 * 109/L, WBC of 4.2 * 109/L, Na+ of 137 mmol/L, K+ of 4.2 mmol/L, urea of 5.2 mmol/L, creatinine of 88 µmol/L, and CRP of 4 mg/L (< 5). What is the most appropriate diagnostic test for her likely diagnosis?