What are the Eye Involvement in IBS?

Episcleritis Painless hyperaemic sclera Occurs with IBD flare No visual disturbance Treat: topical corticosteroids

Scleritis Painful & red Inflammation deep scleral blood vessels Visual disturbance

Uveitis (anterior / intermediate / posterior) Painful, can lead to blindness Treat: steroids / ciclosporin

Diversion colitis

Diversion colitis is a nonspecific inflammatory disorder that occurs in segments of the colon and rectum that are diverted from the faecal stream by surgery (eg, creation of a loop colostomy/ileostomy or an end colostomy/ileostomy with closure of the distal colon segment [eg, Hartmann's procedure]).

Radiation proctitis

Radiation enteropathy is thought to occur in around 2%–20% of patients undergoing radiotherapy for pelvic cancers. Radiation damage to the colonic epithelium leads to obliteration of end arterioles and chronic ischaemia. In order to improve perfusion, neovascularisation occurs, resulting in the formation of telangiectatic vessels which are prone to bleeding.

Complications of polypectomy: Bleeding 1

Most frequent complication. 
Primary: Usually immediately visible.
Secondary: delayed.

Immediate haemorrhage:
Usually a slow ooze , can be arterial spurt.
Treat immediately.
Re-snare / endo-loop the remaining stalk.
If bleeding recurs try clip/ electrocoagulation. 
Selective arterial catheterization and embolization.

Secondary haemorrhage:
Up to 14 days after polypectomy.
Usually After the removal of large-stalked polyps. 
Hot biopsy, over-large polyps. 
Transfusion may occasionally be required

Schatzki ring

Schatzki ring, My Gastro room

The pathogenesis of Schatzki rings is not clear, and at least 4 hypotheses have been proposed. These hypotheses may not be mutually exclusive. Proposed hypotheses are as follows:

1. The ring is a pleat of redundant mucosa that forms when the esophagus shortens transiently or permanently for unknown reasons.
2. The ring is congenital in origin.
3. The ring    actually a short peptic stricture occurring as a consequence of gastroesophageal reflux disease.
4. The ring is a consequence of pill-induced esophagitis.

Schatzki ring is quite common and may be found in as many as 15% of all patients undergoing barium swallow studies; however, few of these patients exhibit any symptoms of dysphagia.

Most patients present with intermittent, episodic, nonprogressive dysphagia to solids. Dysphagia to liquids is usually not present.

Using a large French mercury bougie, polyvinyl bougie, or a balloon, esophageal dilatation is used with the intention of fracturing the ring—not merely stretching it.

Hepatitis C viral infection: Questions and comments

1-a 34 year old man with hepatitis C attended for review after treatment for 12 weeks with peginterferon and ribavirin co-therapy. He complained of lethargy and SOB on exertion. I vestigation prior to treatment confirmed genotype 1 and a viral load of 1.3 x 10 to 6 with no evidence of cirrhosis.

Investigations:
Hb 10
Plt 65
neutrophils 0.8
LFT normal
U&E normal

what is most approperiate next step in management?
1-continue same treatment

2-Blood transfusion

3-reduce peginterferon

4-reduce ribavirin

5-stop treatment

During the treatment of HCV infection, assess for side effects at week 1,2,4 and then 4-8 weekly.
Ribavirin can cause anaemia.
Action: reduce dose, consider transfusion if Hb less than 10

Peg-interferon alfa can cause:
flu-like symptoms,usually subside in few weeks
neutropenia nad thrombocytopenia
consider dose reduction if neutrophills less than 0.75, Plts less than 50

other side effects includes: depression, irritability, sleeping disorders

stop treatment if hepatitis flare up ALT > 10 time ULN or severe bacterial infection.

Question, what is the diagnosis?

A 31 year old male had one episode of unprotected sex whilst in holiday 3 month ago. two month later he developed lethargy, fletting artheralgia and night sweats. He also complained of severe pain in the right hypochondrail area which radiate into the right testicle.his GP had recently started him on antidepressants. there is no history of diarrhoea or dysurea.six years previously he was treated for genital herpes simplex infection.

On examination he was febrile. there was no lymphadenopathy.he joints appeared normal. abdominal examination revealed a palpable liver edge and spleen. there was evidence of right epdidimorchitis.

Hb             13

WCC             5

Plt             230

AST             60

ALT             80

ALP             60

Bili             70

Urethral swap: no evidence of chlamydia or gonococcus

What is the diagnosis?

1)    HIV seroconversion

2)    Whipple’s disease

3)    Reiter’s disease

4)    Brucellosis

5)    Lymphoma

Bacterial causes of food poisoning

Organism	Source/vehicles	Incubation period	Symptoms	Diagnosis	Recovery
Staphylococcus aureus	Man - contaminated food and water	2-4 h	Diarrhoea, vomiting and dehydration	Culture organism in vomitus or remaining food	< 24 h
E. coli	Salads, water, ice	24 h	Watery diarrhoea	Stool culture	1-4 days
E. coli O157:H7	Cattle - meat, milk	12-48 h	Watery diarrhoea ± haemorrhagic colitis, HUS	Stool culture	10-12 days
Yersinia enterocolitica	Milk, pork	2-14 h	Abdominal pain, vomiting, diarrhoea	Stool culture	2-30 days
Bacillus cereus	Environment - rice, ice-cream, chicken	1-6 h 6-14 h	Vomiting	Culture organism in faeces and food	Rapid
Clostridium perfringens	Environment - contaminated food	8-22 h	Watery diarrhoea and cramping pain	Culture organism in faeces and food	2-3 days
Listeria monocytogenes	Environment - milk, raw vegetables dairy products, unpasteurized cheese	?	Colic, diarrhoea and vomiting	Stool culture	?
Vibrio parahaemolyticus	Seafood	2-48 h	Diarrhoea, vomiting	Stool, food	2-10 days
Clostridium botulinum	Environment - bottled or canned food	18-24 h	Brief diarrhoea and paralysis due to neuromuscular blockade	Demonstrate toxin in food or faeces	10-14 days
Salmonella spp.	Cattle and poultry - eggs, meat	12-48 h	Abrupt diarrhoea, fever and vomiting	Stool culture	Usually 3-6 days, but may be up to 2 weeks
Campylobacter jejuni	Cattle and poultry - meat, milk	48-96 h	Diarrhoea ± blood, fever, malaise and abdominal pain	Stool culture	3-5 days
Shigella spp.	Man - contaminated food and water	24-48 h	Acute watery, bloody diarrhoea	Stool culture	7-10 days

infectious diarrhea

Bloody diarrhoea:

1)    shigella

Basillary dysentery

IP 2-3 days

Oro-feacal

C/F:

Bloody diarrhoea

Sudden fever

Abd pain

Stool microscopy: no trophoziote

Association: spondyloartheritis

Treatment; cipro

2)    Amaebiasis

Amaebic dysentery

IP 1-4 weeks

Oro-feacal

C/F:

abd pain

diarrhoea ,start slowly ,then become perfuse and bloody

stool microscopy;trophozoite

treatment: metronidazole

diloxamide for chronic disease

   

3)    salmonella

IP 12-48 hrs

Gm –ve bacilli

Egg, meat and poultry

C/F:

Bloody diarrhoea

Abd pain

Vomiting

Local infection

Treatment: cipro

4)    compylobactor

IP 2-5 days

Gm –ve rods

C/F:

Severe abd pain (may mimic acute abdomen)

Bloody diarrhoea

Non bloody diarrhoea:

Giardiasis:

IP 1-4 weeks

Flagellate protozoa

Colonize duodenum and jejunum

C/F

Explosive diarrhoea

Offensive

Bloating

what is your diagnosis?

A 62 years oled male presented with severe chest pain and hypotension after vomiting.

Ct shows bilateral pleural effusion and pneumomediastinum to the aorta and to the right of the oesophagus. Subsequent CT with oral contrast shows dense contrast in the oesophagus (arrow) and leakage into the irregular complex right mediastinal collection.

The diagnosis is Boerhaave syndrome.

Spontaneous rupture of the oesophagus during vomiting.

May follow alcohol ingestion or lage meal.

Rupture typically located at the left subdiaphragmatic portion of the oesophagus.

Classical presentation: Mackler traid:

-Vomiting

-Severe chest pain

-Subcutaneous emphysema