EMQs in Clinical Medicine.pdf - Peshawar Medical College

188 The abdomen and surgery
Treatment involves the use of medication used to treat reflux oesophagitis
(proton pump inhibitors, H 2 -receptor antagonists, etc.) and also laser therapy
to ablate intestinal metaplasia and allow regrowth of squamous epithelium.
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A 40-year-old woman presents with haematemesis after a bout of
prolonged vomiting.
A Mallory–Weiss tear is a mucosal tear at the gastro-oesophageal
junction secondary to a sudden increase in pressure in that area usually
mediated by a bout of severe coughing or vomiting. Alcohol binging and
consequent vomiting are a major cause of Mallory–Weiss tear. Actively
bleeding tears can be treated at endoscopy with electrocoagulation.
Antiemetic therapy provides the mainstay of medical treatment.
A 60-year-old woman with pernicious anaemia presents with a
2-month history of dyspepsia, weight loss and haematemesis.
Examination reveals an enlarged left supraclavicular node.
Pernicious anaemia (a condition characterized by atrophy of gastric
mucosa and lack of intrinsic factor) is a risk factor for gastric carcinoma.
Other risk factors include smoking and partial gastrectomy. An enlarged
left supraclavicular node is known as a Virchow node and is an indicator
of poor prognosis (Trousseau’s sign).
74 Diarrhoea
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A 19-year-old backpacker presents with a 2-day history of vomiting
and watery diarrhoea.
Stool microscopy and culture is particularly important because the
patient has recently been abroad.
Management should involve maintaining good oral fluid intake to
replace fluids lost in diarrhoea and vomiting. Antibiotics are indicated if
the patient is systemically unwell.
A 75-year-old patient treated with broad-spectrum antibiotics presents
a few days later with bloody diarrhoea.
Pseudomembranous colitis (PMC) is caused by overgrowth of Clostridium
difficile after antibiotic therapy. An important primary measure is to discontinue
the suspected antibiotics because this can sometimes be sufficient
to relieve symptoms. Metronidazole is the treatment of choice.
An anxious 31-year-old woman complains of a history of chronic
diarrhoea alternating with constipation. She often feels bloated.
Investigations are normal.
Irritable bowel syndrome is often more severe during times of stress.
Some patients report relief of abdominal pain on passing flatus/
defecation. Women are more frequently affected than men.