CPC-1385/12/10CPC-1385/12/10

Dr.Ahmad Khosravi Dr.Ahmad Khosravi Ghaem Hospital Ghaem Hospital

Mashad universityMashad university

HXHX

•17y male 17y male

•Chronic diarrhea Chronic diarrhea

• Abdominal pain (colicky)Abdominal pain (colicky)

•Low grade fever Low grade fever

•AnorexiaAnorexia

•weight lossweight loss

•Dry couphDry couph

PMHPMH

•Dyspepsia(-)Dyspepsia(-)

•Hematemesis (-)Hematemesis (-)

•Melena (-)Melena (-)

•Hematochesia (-)Hematochesia (-)

• Jundice (-)Jundice (-)

•Cigarret,alcohol,opium(-)Cigarret,alcohol,opium(-)

PEPE

• Lean body weightLean body weight• PalePale• PR= 90/min BP= 110/80 mm/HgPR= 90/min BP= 110/80 mm/Hg

RR= 15/min RR= 15/min T= 38°T= 38°• Thyroid ,Mucoses,Heart,Lung:NThyroid ,Mucoses,Heart,Lung:N• LAP:(-)LAP:(-)• Jundice:(-)Jundice:(-)• Extrimity: NExtrimity: N• CNS:NCNS:N

Abd. ExaminationAbd. Examination

• Inspection:NInspection:N

• Auscultation:NAuscultation:N

• Palpation:Mild diffuse tenderness Palpation:Mild diffuse tenderness without reboundwithout rebound

• No Organomegaly,mass,ascitisNo Organomegaly,mass,ascitis

• TR:NTR:N

• Extrimity: NExtrimity: N

• CNS:NCNS:N

Lab.dataLab.data• WBC:11000WBC:11000• P:82P:82%%,L:14,L:14%%M:4M:4%%• Ht:29, Hb:10.6, Ht:29, Hb:10.6,

MCV:77MCV:77• ESR:55/1hESR:55/1h• SFe:52 mi.gSFe:52 mi.g • TIBC:380mi.g /dl TIBC:380mi.g /dl • Ferritin 35 mg/ml Ferritin 35 mg/ml • S/E(OB+, S/E(OB+, OP-OP-))• U/A x 3NLU/A x 3NL• PPD (-)PPD (-)•   ATTG (-), AEM Ab(-)ATTG (-), AEM Ab(-)

• FBS:95 mg/dlFBS:95 mg/dl• Cr:0.6 mg/dlCr:0.6 mg/dl• Ca:8.6 mg/dlCa:8.6 mg/dl• P:4.1 mg/dlP:4.1 mg/dl• Na:134 meq/lNa:134 meq/l• K:3.3 meq/lK:3.3 meq/l• Uric Acid: 6 mg/dlUric Acid: 6 mg/dl• LDH:240LDH:240• CRP :+ + +CRP :+ + +• LFT, PT:NLLFT, PT:NL• TFT:NLTFT:NL• HBSAg,HIV:NegHBSAg,HIV:Neg• Chol:86 mg/dlChol:86 mg/dl• TG:210 mg/dlTG:210 mg/dl

DDDD• INFECTIONS: INFECTIONS: Tuberculosis,AmebiasisTuberculosis,Amebiasis

• IBD AND ORTHER ENTERO COLITIS: IBD AND ORTHER ENTERO COLITIS: Eosinophilic gastroenteritis Eosinophilic gastroenteritis

Chronic nongranolomatous ulcerative jejunoileitisChronic nongranolomatous ulcerative jejunoileitis Radiation Colitis Radiation Colitis

Collagenous, Lymphocytic ColitisCollagenous, Lymphocytic Colitis • VASCULAR: VASCULAR: Ischemic ColitisIschemic Colitis,,vasculitisvasculitis

• CELIAC SPRUECELIAC SPRUE• NEOPLASIA : NEOPLASIA : Adenocarcinoma, Lymphoma, ….Adenocarcinoma, Lymphoma, ….

• IBSIBS• NSAID-induced injuriesNSAID-induced injuries• AMYLOIDOSISAMYLOIDOSIS• SARCOIDOSISSARCOIDOSIS

Clinical diagnosisClinical diagnosis

•TBTB

•Crohn’ s diseaseCrohn’ s disease