EMQs in Clinical Medicine.pdf - Peshawar Medical College

Treatment of gastrointestinal conditions – answers 191
A
D
Strictures and fistulae are typical of Crohn’s disease. Ulceration and fissuring
give rise to ‘rose thorn’ ulcers. There is discontinuous involvement
of the gastrointestinal tract with skip lesions.
A 45-year-old man presents with severe epigastric pain and vomiting.
Abdominal film shows absent psoas shadow and ‘sentinel loop’ of
proximal jejunum.
The absence of the psoas shadow is the result of a build up of retroperitoneal
fluid. The sentinel loop refers to a segment of gas-filled proximal
jejunum. However, it is important to remember that an abdominal plain
film can be completely normal in a patient presenting with acute
pancreatitis.
77 Treatment of gastrointestinal conditions
Answers: E A J G H
E
A
J
G
H
A 50-year-old man presenting with a perforated gastric ulcer.
This is a surgical emergency and requires laparotomy for surgical repair.
A 55-year-old woman with severe oesophagitis confirmed on
endoscopy.
High-dose proton pump inhibitor is indicated as first-line treatment to
ensure healing. Once healed, low-dose therapy can be continued.
A 60-year-old man with cirrhosis presenting with haematemesis.
Acute upper gastrointestinal bleeding is most commonly caused by
peptic ulcer disease, except in patients with known cirrhosis when variceal
bleeding is the cause in 85 per cent of cases. Suspected oesophageal
varices are an indication for upper gastrointestinal endoscopy.
A 30-year-old man with ulcerative colitis presents to A&E with fever,
tachycardia and abdominal distension.
This is presentation of severe ulcerative colitis and intravenous
hydrocortisone is indicated.
Other markers of a severe attack are anaemia, marked rectal bleeding and
an ESR significantly raised from baseline. When the patient improves
after a few days, oral prednisolone and a maintenance agent such as
sulfasalazine (sulphasazine) can be prescribed.
A 24-year-old woman with suspected irritable bowel syndrome
complains of colicky pain and bloating.
Mebeverine is an anti-spasmodic agent and relieves symptoms in some
patients. This agent has the advantage of relaxing intestinal smooth
muscle without anti-cholinergic side effects.