A 12 month old child is brought into see the paediatrician for failure to
thrive. Soon after birth the child's growth drops below the 10th centile. The
child has had three episodes of pneumonia and since starting solids mum comments
the stools are often pale and offensive. Measure of sweat content demonstrates
elevated chloride.
A 50 year old gentleman presents with chronic abdominal pains and pale, floating
stools. His has several episodes of alcoholic pancreatitis and one occasion had
a prolonged hospital stay after surgery for complications resulting from it.
What is the underlying issue now?
A 35 year old female presents with offensive smelling stools for several weeks.
She has a history of alternating bowel habit with bouts of diarrhoea and then
constipation. She also takes codeine frequently for chronic back pain which she
admittedly says also 'slows her down'. A previous colonoscopy was normal and her
gastroenterologist concluded she had irritable bowel syndrome.
A 50 year old sees a doctor for chronic diarrhoea and a set of blood tests
are drawn. He notes that the patient has a mild anaemia with haemglobin 80mg/dL
and normal MCV. He asks for a blood picture which shows a bimodal picture of
microcytic and macrocytic cells. He proceeds to order several tests to establish
the cause. What are potential explanations and explain the mechanism.
A 60 year old woman undergoes extensive small bowel resection due to severe
Crohn's disease. A few months later she develops unexplained bruises appearing
on her body over a few weeks. Her doctor orders a clotting profile and platelet
count. Why is this occurring? A few weeks later, she suffers a fall and breaks
her wrist. The xray confirms the fracture but also show low bone density
consistent with osteoporosis. Can you explain this in the context of her
previous history?
A 40 year old male presents with weeks of gradually worsening numbness and loss
of balance. Ten years earlier he had an emergency partial gastrectomy due to
uncontrolled bleeding from a untreated stomach ulcer. He has been on PPI.
Explain reasons for his symptoms?
A 45 year with chronic liver disease develops abnormal bowel motions. The stools
are bulky and yellow and definitely not pale. What is the mechanism for this.
As part of a work-up for their malabsorption (and whilst waiting for imaging studies and colonoscopy), a patient undergoes the following investigations - 24 hour faecal fat, H2 breath test, pancreatic elastase and Schilling test. Explain the rationale for doing these tests.
A 55 year old male with chronic pancreatic insufficiency is commenced on pancreatic enzyme supplements to improve weight gain. These temporarily work but after a few months he develops recurrent diarrhoea despite compliance to therapy. Give other reasons why he continues to malabsorb.