Liver & GIT
A 20 year old male presents with mucus and repeated gastrointestinal bleeding. Patient is positive for ANCA. The most likely diagnosis is:
|D||Ischemic bowel disease|
Clinical features- Clinical features depend on the site and severity of involvement.
a. Rectum involvement – It pass fresh blood or blood stained mucus. Tenesmus,and fecal urgency are common. No abdominal pain is present.
b. Sigmoid colon involvement- It result in slowness of proximal transit leading to constipation.
c. Colon involvement- Bloody diarrhea as transit through inflamed colon increased. Pus may be present. Diarrhea is often nocturnal and post prandial. Abdominal pain and tenderness are frequent.
a. Anemia b. Raised ESR, CRP levels.
c. Increased platelet count d. Low serum albumin e. Leukocytosis.
1. P-ANCA (60-70%)
2. Anti-saccharomyces cerevisiaeantibody(10-15%)
3. Anti goblet cell antibody (40%)
4. Anti colon antibody (36%)
5. Pancreatic autoantibody (41%)
a. Sigmoidoscopy – to assess disease activity.
b. Colonoscopy- To determine extend of disease and subsequent need for cancer surveillance. But it should not be performed in severe disease due to risk of perforation.
a. Plain abdominal X-ray- colonic dilation can be seen in severe disease.
b. Barium enema –
i. Earliest change is fine mucosal granularity
ii. Deep ulceration appear as ‘ collar-button’Q ulcers.
iii Loss of haustration Qin long standing disease colon become shortened and narrowed.
iv Polyp can be seen which may be due to post inflammatory polyp, pseudopolyp, adenomatous polyps or carcinoma.
c. U/S- i. Mild mural thickening ii. Inhomogeneous wall density
iii. Increased perirectal and pre sacral fat, iv. Target appearance of rectum and adenopathy.