A 36-year-old man presents to the hospital with dehydration due to diarrhoea. He reports having loose brown stool four times a day and denies any previous gastrointestinal infections. On examination, his abdomen is mildly tender with no guarding or rebound tenderness, and his observations are within the normal range. His blood tests reveal elevated WBC count and positive stool test for Clostridium difficile toxin. What is the recommended first-line treatment for this patient?
A 50-year-old man presents with abdominal pain, diarrhoea, and a 3 kg weight loss over the past few months. He reports feeling lethargic and experiencing crampy abdominal bloating. On examination, there is minor muscle wasting in the buttocks and shoulders, as well as several oral aphthous ulcers. Lab results show a low hemoglobin level, low albumin level, low IgA level, and a low serum ferritin level. What is the most probable diagnosis?
A 28 year-old man visits his GP with concerns about having bowel cancer. He has no current clinical indications of bowel cancer and is not taking any medication. His father passed away from colon cancer at the age of 47 and his paternal uncle was diagnosed with bowel cancer at the age of 42. He underwent a colonoscopy four months ago which showed no abnormalities.
During his abdominal examination, no abnormalities were found. You schedule a colonoscopy for the patient in 2 years.
What is the next appropriate step in management?
A 45-year-old patient with acromegaly and an elevated IGF-1 level visits the clinic to discuss the findings of a screening colonoscopy. During the procedure, a 5 mm and a 7 mm tubular adenoma were detected in the sigmoid colon, while the rest of the colonoscopy was unremarkable. What is the recommended follow-up plan?
A 50-year-old patient with ulcerative colitis presents at the clinic to review the findings of a screening colonoscopy. The examination revealed mild disease activity up to the splenic flexure and a mild sigmoid stricture. What follow-up plan should be recommended?
A 38-year-old man with a 10-year history of ulcerative colitis, previously treated with intravenous hydrocortisone and currently managed with azathioprine, underwent routine screening colonoscopy. Although extensive colitis was observed, there was no active endoscopic inflammation or post-inflammatory polyps, and mapping biopsies showed no histological inflammation. The patient expressed concern about his future risk of colorectal cancer and willingness to undergo surveillance colonoscopy at the recommended time interval. Based on this information, when should the patient schedule his next surveillance colonoscopy?
A 55-year-old man with a history of gout is currently taking allopurinol. He also has Crohn’s disease, which was diagnosed a year ago, and is currently on a daily dose of 20 mg of prednisolone. Despite having no other significant health issues, he has been gaining a considerable amount of weight. Whenever his steroid dose is reduced to 15 mg, he experiences diarrhoea up to four times a day and requires hospitalization for intravenous steroid therapy. This has happened three times so far. To facilitate the taper, you plan to introduce a steroid-sparing agent. However, you need to avoid a particular agent due to its significant interaction with allopurinol. Which agent should be avoided?
A 55-year-old male Chinese patient who has recently relocated to the UK complains of chronic diarrhoea. His family reports that he has been experiencing deteriorating memory loss, depression, and insomnia. Upon examination, you observe dermatitis, tremors, and ataxia. His blood tests show normal full blood count, renal function, liver function, and bone profile. You suspect that he may have a nutritional deficiency. What vitamin is he most likely deficient in?
A 68-year-old woman presents with right upper quadrant pain and jaundice. An abdominal ultrasound reveals a gallstone in the common bile duct and intrahepatic bile duct dilatation. She is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP) to remove the stone. Based on the 2008 British Society of Gastroenterology guidelines for common bile duct stone management, what is the most frequent complication associated with this procedure?
A 45-year-old man with primary biliary cirrhosis and worsening liver function is in need of a liver transplant.
What is a factor that would make him ineligible for the procedure?