Gastrointestinal & Hepatobiliary

Reference: Practical Manual in Clinical Medicine by Professor ABM Abdullah; P-251

Reference: Davidson 23rd; P-799

Reference: Davidson 23rd; P-825

Reference: Davidson 23rd Fig. 21.9

Reference: Davidson 23rd, Box-22.5

Explanation: The major symptoms are abdominal pain, diarrhoea and weight loss. Ddiarrhea, which is usually watery and does not contain blood or mucus.

Reference: Davidson 23rd; P-868

Reference: Davidson 23rd; P-814

Reference: Davidson 23rd; P-793

Reference: Davidson 23rd; P-857
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-825

Reference: Davidson 23rd; P-841

Explanation: Endoscopy is the preferred investigation for diagnosis of peptic ulcer disease

Reference: Davidson 23rd; P-825
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-799

Reference: Davidson 23rd, Box-21.78

Reference: Davidson 23rd; P-889
Explanation: On liver biopsy, the characteristics early features of PSC are periductal ‘onion skin’ fibrosis and inflammation.

Reference: Davidson 23rd; P-862
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-859
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Individual hepatocytes are separated from the leaky sinusoids by the space of Disse, which contains stellate cells that store vitamin A and play an important part in regulating liver blood flow.

Explanation: Ultrasound scanning can confirm the diagnosis of acute pancreatitis

Reference: Davidson 23rd; P-872
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-868

Stem Breakdown:

Epigastric pain, nausea, and vomiting: These are common symptoms of peptic ulcer disease (PUD).
Pain worsens after meals and improves with antacids: This suggests acid-related irritation, consistent with PUD. Antacids neutralise stomach acid, providing relief.
History of NSAID use: NSAIDs are a known risk factor for PUD because they inhibit prostaglandin synthesis, reducing the protective mucus layer in the stomach.
Option Analysis:

A) Peptic ulcer disease: This is the correct diagnosis. Davidson and Harrison explain that peptic ulcer disease is characterised by the formation of ulcers in the stomach or duodenum, often caused by NSAID use or Helicobacter pylori infection. NSAIDs disrupt the stomach’s protective mechanisms, leading to ulceration. Epigastric pain that worsens after eating and improves with antacids is typical of PUD.
B) Acute pancreatitis: Pancreatitis causes severe epigastric pain that radiates to the back, along with nausea and vomiting. The pain is typically worse after eating, but antacids do not relieve it. Pancreatitis is more often associated with elevated amylase and lipase levels.
C) Gallstones: Gallstones cause biliary colic, a sharp right upper quadrant pain that may radiate to the shoulder. The pain is not typically relieved by antacids, and gallstones are more common in women and those with risk factors like obesity and pregnancy.
D) Gastro-oesophageal reflux disease (GERD): GERD can cause epigastric pain and heartburn, but the pain is more likely to be retrosternal (behind the breastbone) and related to reflux of stomach acid into the oesophagus. GERD is associated with regurgitation and burning sensation rather than pain that improves with antacids.

Explanation: durug causes dyspepsia are NSAIDs, Glucocorticoids, Iron and potassium, supplements

Reference: Davidson 23rd; P-800
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd Box 21.15

Chest pain with Breathlessness: IHD, pulmonary embolism, pleurisy, anxiety.
Chest pain with Nausea, vomiting or sweating: acute myocardial infarction.
Chest pain with Burning in chest or epigastrium: GERD

Reference: Davidson 23rd; P-886, box: 22.50

Explanation: Causes of Right iliac fossa mass are: Caecal carcinoma, Crohn’s disease & Appendix abscess

Management
The aims of management are to relieve symptoms, induce healing and prevent recurrence. H. pylori eradication is the cornerstone of therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients.

Page-814

Anorexia, nausea, vomiting–acute viral hepatitis, may be drug induced hepatitis.
Itching with pale or dark pale stool–obstructive jaundice.
Long standing jaundice with itching, pigmentation of skin–primary biliary cirrhosis.

Explanation: histological features of Ulcerative colitis are: Inflammation limited to mucosa, crypt distortion, cryptitis, crypt abscesses, loss of goblet cells,

Reference: Davidson 23rd; P-841

Explanation: Option A,B,D causes obstructive jaundice

Reference: Davidson 23rd; P-783
Explanation : The most common cause is irritable bowel syndrome which can present with increased frequency of defecation and loose , watery or pellety stools.

Reference: Davidson 23rd; P-137

Stem Breakdown:

Abdominal pain, bloating, and altered bowel habits: These symptoms suggest a gastrointestinal disorder, possibly involving the colon.
Multiple polyps throughout the colon on colonoscopy: This finding is characteristic of familial adenomatous polyposis (FAP), a hereditary condition associated with numerous adenomatous polyps and a high risk of colorectal cancer.
Option Analysis:

A) Familial adenomatous polyposis (FAP): This is the correct diagnosis. Davidson and Harrison explain that FAP is an autosomal dominant disorder caused by mutations in the APC gene, leading to the development of hundreds to thousands of adenomatous polyps in the colon. If left untreated, FAP almost inevitably leads to colorectal cancer.
B) Peptic ulcer disease: Peptic ulcer disease causes epigastric pain, often related to meals, but it affects the stomach and duodenum, not the colon, and does not cause polyps.
Crohn’s disease: Crohn’s disease is an inflammatory bowel disease that can affect any part of the gastrointestinal tract, but it does not cause multiple polyps throughout the colon. It typically presents with skip lesions and transmural inflammation.
D) Diverticulosis: Diverticulosis involves the formation of small pouches (diverticula) in the colon, usually in the sigmoid colon, but it does not cause multiple polyps. It is often asymptomatic but can lead to diverticulitis (inflammation of diverticula).

Kayser-Fleischer rings are brown or green deposits of copper seen around the cornea in patients with Wilson’s disease. Davidson explains that Wilson’s disease is a genetic disorder characterised by the accumulation of copper in the liver, brain, and other tissues due to a defect in copper excretion. Harrison emphasises that Kayser-Fleischer rings are pathognomonic for Wilson’s disease, and treatment involves copper chelation therapy.

Reference: Davidson 23rd, Box-4.4

Reference: Davidson 23rd; P-777
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: Gastrin stimulates gastric acid secretion. Somatostatin, Secretin and GIP inhibits gastric acid secretion.

Reference: Davidson 23rd; P-856
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: persistent daily vomiting suggests gastric outlet obstruction

Reference: Davidson 23rd; P-872
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-860
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Ref: Davidson 23rd; P-1003 , box : 24.31

Reference: Davidson 23rd; P-774

Reference: Davidson 23rd; P-825

Reference: Davidson 23rd Fig. 21.19 most common cause of Upper GIT bleeding is PUD

Reference: Davidson 23rd; P-852
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-765
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-835
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-853
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Stem Breakdown:

Chronic diarrhoea, weight loss, and iron deficiency anaemia: These symptoms are indicative of malabsorption, which is a hallmark of coeliac disease.
Pruritic, blistering rash on elbows and knees: This describes dermatitis herpetiformis, a skin manifestation of coeliac disease.
Option Analysis:

A) Coeliac disease: This is the correct diagnosis. Davidson and Harrison explain that coeliac disease is an autoimmune disorder triggered by gluten ingestion, leading to small intestinal damage and malabsorption. Chronic diarrhoea, weight loss, and iron deficiency anaemia are common presentations. Dermatitis herpetiformis, a pruritic vesicular rash, is pathognomonic for coeliac disease.
B) Crohn’s disease: Crohn's disease can cause chronic diarrhoea and weight loss, but it typically presents with other features such as abdominal pain, perianal disease, or fistulas. Additionally, dermatitis herpetiformis is not associated with Crohn’s disease.
C) Ulcerative colitis: Ulcerative colitis primarily affects the colon, causing bloody diarrhoea and abdominal pain. It does not cause malabsorption or dermatitis herpetiformis.
D) Irritable bowel syndrome (IBS): IBS is a functional gastrointestinal disorder characterised by abdominal pain and altered bowel habits, but it does not cause malabsorption, weight loss, or iron deficiency anaemia.

Reference: Davidson 23rd; P-862
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-795
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Gastric aspiration and/or lavage is very infrequently indicated in acute poisoning, as it is no more effective than activated charcoal for most substances and complications are common, especially pulmonary aspiration. It is contraindicated if strong acids, alkalis or petroleum distillates have been ingested

Explanation: The most common cause of Chronic or relapsing diarrhea is irritable bowel syndrome

Explanation: Alcoholic liver disease is the leading cause of cirrhosis in the Western world. Davidson describes that chronic alcohol consumption leads to progressive liver inflammation, fibrosis, and eventually cirrhosis. Harrison explains that while viral hepatitis and non-alcoholic fatty liver disease are rising causes of cirrhosis, alcohol remains the most common etiology in developed countries due to its widespread consumption.