A 28-year-old woman with Crohn’s disease (CD) visits her primary care physician for a regular follow-up. During the examination, the doctor observes clubbing, hepatomegaly, and episcleritis, which are known signs linked with CD. What other non-intestinal symptom is commonly associated with CD?
A 35-year-old man presents with sudden onset abdominal pain that worsens when lying down. He reports feeling nauseous and has been vomiting. The nursing staff notes that he has a rapid heart rate and a fever of 38.1°C. Upon examination, his abdomen is tender and there is significant guarding. Bruising is present around his belly button. The patient admits to drinking six cans of strong beer daily and smoking two packs of cigarettes per day. He recalls being hospitalized two years ago for vomiting blood but cannot remember the treatment he received. He has no other significant medical history and does not take any regular medications. What is the most likely cause of the man’s symptoms and presentation?
A 29-year-old Caucasian man presents with a 3-month history of diarrhoea, fatigue, and weight loss. He denies any history of alcohol or drug abuse. He frequently travels to southern India for work. Laboratory tests show mixed macrocytic anaemia with low levels of serum folate and vitamin B12. Stool examination is negative for ova and parasites. A small bowel biopsy reveals predominant mononuclear infiltration and villous destruction throughout the small intestine. What intervention is most likely to improve his symptoms?
A 50-year-old man was admitted for an endoscopic retrograde cholangio-pancreatography (ERCP) due to biliary colic. He had an uneventful procedure, but was re-admitted the same night with severe abdominal pain. He is tachycardic, short of breath, and has a pleural effusion on his chest X-ray (CXR). His blood tests show C-reactive protein (CRP) 200 mg/litre, white cell count (WCC) 16 × 109/litre, creatine 150 µmol/litre, urea 8 mmol/litre, phosphate 1.1 mmol/litre, calcium 0.7 mmol/litre.
What is his most likely diagnosis?
A 55-year-old woman visits her GP complaining of a burning sensation in her chest after eating meals for the past 2 months. She explains that this pain usually occurs after consuming heavy meals and can keep her up at night. Despite trying over-the-counter antacids, she has found little relief. The pain is retrosternal, without radiation, and is not aggravated by physical activity. She denies any difficulty or pain while swallowing and has not experienced any weight loss. She is worried that she may be having a heart attack every time this happens as both her parents died from coronary artery disease. She has no other medical conditions and is not taking any regular medications. An ECG reveals normal sinus rhythm without ischaemic changes. What is the most probable diagnosis?
A 40-year-old woman from Vietnam presents with abdominal swelling. She has no history of blood transfusion or jaundice in the past and is in a stable relationship with two children. Upon admission, she was found to be icteric. During the investigation, she experienced a bout of haematemesis and was admitted to the High Dependency Unit.
What is the most probable cause of her symptoms?
A 65-year-old man (with known metastatic pancreatic cancer) presented with severe obstructive jaundice and signs of hepatic encephalopathy. He was treated with a biliary stent (percutaneous transhepatic cholangiography (PTC)) and discharged when his jaundice, confusion and pruritus had started to improve. He re-presented shortly after discharge with rigors, pyrexia and feeling generally unwell. His blood cultures showed Gram-negative rods.
What is the most likely cause of his current presentation?
A 38-year-old woman was found to have constipation-predominant irritable bowel syndrome and frequently used over-the-counter laxatives. During a colonoscopy for rectal bleeding, her colon was noted to be abnormal and a biopsy was taken. What is the most probable histological result in this scenario?
A 50-year-old woman comes to the Emergency Department complaining of abdominal pain, nausea, and vomiting that started 4 hours ago after a celebratory meal for her husband’s 55th birthday. She has experienced similar discomfort after eating for a few years, but never with this level of intensity. On physical examination, there is tenderness and guarding in the right hypochondrium with a positive Murphy’s sign. What is the most suitable initial investigation?
A 42-year-old man, who is a heavy drinker, presents with massive haematemesis. His vital signs are: pulse = 110 bpm, blood pressure = 80/40 mmHg, temperature = 36.8 °C and respiratory rate = 22 breaths per minute. On physical examination in the Emergency Department, he is noted to have gynaecomastia and caput medusae.
Which of the following conditions is most likely causing the haematemesis?