A 40-year-old male with a history of Ulcerative colitis (UC) presents with fatigue, abdominal pain, and generalized itching. During the examination, he is found to be jaundiced, and his blood tests reveal a significantly elevated bilirubin and alkaline phosphatase. An MRCP indicates the presence of multiple strictures in the biliary tree.
What is the probable diagnosis?
A 50-year-old man with a history of ulcerative colitis attends the Gastroenterology Clinic for review. Over the past few months, his bowel symptoms have been generally quiescent, but he has suffered from tiredness and itching.
On examination, you notice that he has jaundiced sclerae and there are some scratch marks on his abdomen consistent with the itching.
Investigations:
Investigation Result Normal value
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Urea 5.6 mmol/l 2.5–6.5 mmol/l
Creatinine 90 μmol/l 50–120 µmol/l
Haemoglobin 110 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 290 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate (ESR) 45 mm/hour 0–10mm in the 1st hour
Autoantibody screen ANCA +, anti-cardiolipin +, ANA +
Alanine aminotransferase (ALT) 75 IU/l 5–30 IU/l
Alkaline phosphatase 290 IU/l 30–130 IU/l
Bilirubin 85 μmol/l 2–17 µmol/l
Which of the following is the most likely diagnosis?
A newborn presents with a suspected diagnosis of pyloric stenosis. What is a characteristic of this condition?
A 32-year-old man presents at the outpatient clinic with altered bowel habit and occasional per rectum bleeding for the past 3 months. During examination, he experiences tenderness on the left iliac fossa and is unable to tolerate a pr examination. His liver function tests at the general practice surgery showed an elevated alkaline phosphatase (ALP) level. Based on these symptoms, which of the following autoantibody screen findings is most likely?
A dishevelled-looking 70-year-old woman is admitted from a nursing home following a fall. Her son indicates that she has become increasingly forgetful over the last 2 months. She has had diarrhoea for the last 3 weeks, thought to be related to an outbreak of norovirus at her nursing home, and has been vomiting occasionally. On examination you notice a scaly red rash on her neck and hands.
What is the most likely diagnosis?
A 16-year-old girl presents to Accident and Emergency with sudden onset abdominal pain. The pain is severe, and has now localised to the right iliac fossa. She has a temperature of 37.6°C (normal 36.1–37.2°C). Other observations are normal. The surgical registrar comes to review this patient. During her examination she flexes and internally rotates her right hip, which causes her pain. She states that this girl’s appendix lies close to the obturator internus muscle.
What is the name of the clinical sign the registrar elicited?
A 26-year old woman has been asked to come in for a consultation at her GP’s office after her blood test results showed an elevated level of anti-tissue transglutaminase antibody. What condition is linked to this antibody?
An obese 60-year-old man presents to his General Practitioner (GP) with ongoing vague abdominal pain and fatigue for the last three months. His past medical history is significant for type 2 diabetes mellitus and hypertension.
Physical examination suggests hepatomegaly. Laboratory studies reveal a negative hepatitis panel and normal iron studies. Antibodies for autoimmune liver disease are also normal.
A diagnosis of non-alcoholic fatty liver disease (NAFLD) is likely.
Which of the following is the most appropriate treatment for this patient?
A 53-year-old woman presents with haematemesis. She has vomited twice, producing large amounts of bright red blood, although the exact volume was not measured. On examination, you discover that there is a palpable spleen tip, and spider naevi over the chest, neck and arms.
What is the diagnosis?
A 43-year-old woman presents with haematemesis. She has vomited twice, producing large amount of bright red blood, although the exact volume was not measured. On examination, you discover that there is a palpable spleen tip, and spider naevi over the chest, neck and arms.
What is the diagnosis?