EMQs in Clinical Medicine.pdf - Peshawar Medical College

186 The abdomen and surgery
food/drinking liquids relieves the discomfort. The symptoms are often
worse when the patient is feeling particularly stressed. It is important to
rule out any other pathology before this diagnosis is made.
K
A
A 40-year-old man complains of intermittent dysphagia associated
with chest pain. Barium swallow reveals a corkscrew oesophagus.
There is abnormal contraction of the oesophagus giving rise to the
corkscrew appearance on barium swallow. Anti-spasmodics can be
prescribed but are not always helpful.
A 55-year-old man presents coughing when he tries to swallow. On
examination he has a flaccid fasciculating tongue.
There is difficulty in coordinating the swallowing movement. There is
lower motor neuron weakness of the muscles supplied by the cranial
nerve which lie in the medulla. The flaccid fasciculating tongue indicates
nerve XII involvement.
72 Lower gastrointestinal bleeding
Answers: E L I J G
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A 62-year-old man presents with rectal bleeding and a year’s history of
left iliac fossa pain and change in bowel habit. There is no weight loss.
Diverticular disease mainly occurs in the sigmoid colon. A high-fibre diet
helps to prevent the high intraluminal pressures that are believed to
cause diverticula.
An 8-month-old baby presents with inconsolable crying, colic and
bleeding per rectum. A sausage-shaped abdominal mass is palpable.
Intussusception is a paediatric surgical emergency and refers to the
invagination of proximal bowel into a distal segment. The most common
pathology involves the ileum passing into the caecum and colon through
the ileocaecal valve. This condition usually occurs in children between the
age of 2 months and 2 years. Presentation is typically with inconsolable
crying, colic (child classically draws the legs up) and a sausage-shaped
mass in the abdomen. The rectal bleeding is sometimes described as
having a redcurrant jelly-like appearance. The condition is usually treated
by rectal air insufflation. If this fails, surgical intervention is indicated.
A 35-year-old man returns from holiday with a 2-week history of
fever, cramping abdominal pain and bloody diarrhoea.
The acute history and recent travel history make infectious diarrhoea the
most likely cause. Stool sample for microscopy, culture and sensitivity is
the investigation of choice. If the patient is systemically unwell, antibiotics
(e.g. empirical treatment with ciprofloxacin) may be started
before diagnosis is confirmed.