Gastroenterology

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disiapkan ? :P :D
 A 65-year-old man is admitted with rectal bleeding. He noticed a
significant amount of blood in the toilet after going to the
bathroom this morning and had some mild cramping just before
that bowel movement. His past medical history is positive for
coronary artery disease (has had stents placed and is on aspirin
and clopidogrel) and osteoarthritis for which he has been taking
ibuprofen. He denies weight loss and has no previous history of
bleeding. On examination he is slightly diaphoretic. Vital signs are
BP 124/72 and pulse 88 with the patient supine, BP 94/52 and
pulse 110 with the patient standing. Abdomen is nontender and
nondistended. NG aspirate is negative for occult blood.

A. Diagnosis?
B. Griffiths' point is one of location where that disease can occur,
Griffiths' point is a point of anastomose between and
 A 65-year-old woman with a complex medical
history (including diabetes, hypertension, coronary
artery disease, gastroesophageal reflux disease,
and ongoing use of alcohol and tobacco) presents
with increasing midsternal chest discomfort
predominantly when swallowing solid food.
Recently, even liquids are becoming problematic.
She has not noted blood in her stool or melena,
weight loss, or change in her energy level.
A. What is the most likely cause of her dysphagia?
B. The effective surgical intervention for the disease
is
A 72-year-old woman notices
progressive dysphagia to solids and
liquids. There is no history of alcohol or
tobacco use, and the patient takes no
medications. She denies heartburn, but
occasionally notices the regurgitation of
undigested food from meals eaten
several hours before. Her barium
swallow is shown.

A. Diagnosis ?
B. Which of the following is the cause of
this condition?
 A 76-year-old white man presents
with painless hematemesis and
hypotension. He has no previous GI
symptoms but did have resection of
an abdominal aortic aneurysm 12
years previously. Emergency EGD
shows no bleeding source in the
stomach or duodenum.
A. Diagnosis ?
B. Surgical Intervention?
 A 34-year-old male presents with substernal
discomfort. The symptoms are worse after meals,
particularly a heavy evening meal, and are
sometimes associated with hot/sour fluid in the
back of the throat and nocturnal awakening. The
patient denies difficulty swallowing, pain on
swallowing, or weight loss. The symptoms have
been present for 6 weeks; the patient has gained
20 lb in the past 2 years.
A. Diagnosis?
B. If the initial therapy is failed, what most
recommended surgical therapy for this patient?
 A 32-year-old white female
presents with a 3-week history
of diarrhea with the passage of
blood and mucus.
Sigmoidoscopy shows
inflamed, friable mucosa from
rectum to midsigmoid. Proximal
involvement is not seen. Biopsy
reveals inflammation with crypt
abscesses.
A. Diagnosis?
B. In the severe case, it can be
develop as shown in the
picture. whats the name of
that complication
 A 35-year-old white man presents with diarrhea,
weight loss, and RLQ pain. On exam, a tender mass
is noted in the RLQ; the stool is guaiacpositive.
Enteroscopy result shown in the picture.

A. typical features found on enteroscopy

called
B. Diagnosis ?
A 16-year-old boy has had lifelong constipation.
He requires suppositories and often enemas to
initiate bowel movements. His abdomen is
distended. Palpation reveals a tubular mass in
the left lower quadrant. Rectal exam reveals no
stool in the vault. Barium enema reveals a
dilated colon above a normal-appearing rectum.

A. What the most likely diagnosis?

B. What is the most likely cause of the disease?
A 40-year-old man comes to your office
complaining of epigastric pain that is
unrelieved by several weeks of antacid
therapy. Endoscopy reveals a duodenal
ulcer.

A. Where the most common location of

duodenal ulcers?
B. Scletopia of that location is as high
as
A 22 yo women admitted to the hospital due to intermittent
hematuria with left flank and abdominal pain. Venography of
renal vein shown that lef renal vein is compressed by the
other structure and illustrated by picture below.

A. diagnosis?
B. One of treatment to decrease the renal vein pressure is
using the venous grafting technique (shown in the picture).
the vein which usually use for this technique is
 B