ADEGOKE ADEGBITE

GI CASE STUDY
A. CASE STUDY 1
Question 1
1. Why should there be concern about bleeding risks- hepatocytes are
responsible for the production of the protein involved in blood clotting
cascade. Defective hepatocytes would most likely decrease clotting
factor production
2. Why is the patients INR elevated in the absence of any anticoagulant
medication- factor VIII and VWF are elevated in liver disease
3. Can his coagulopathy be permanently corrected- through liver
transplant
Question 2
1. Why does the patient have anarsaca and ascites- Because of the low
level of protein in the blood( reduced oncotic pressure), particularly
albumin, there will be extravasation of fluid into the interstitial spaces
leading to anarsaca
2. Can this be permanently corrected- Yes. Medication and correction of
the underlying cause
Question 3
1. To what do you attribute the change in mental state- Liver failure was
due to alcohol abuse, possible of thiamine deficiency ( wernickes
encephalopathy) due to chronic alcohol consumptiom
2. Yes, stop alcohol consumption and thiamine supplement
B. CASE STUDY 2
Difference between conjugated and unconjugated bilirubin
Conjugated bilirubin are water soluble, and undergone conjugated
by the liver while unconjugated bilirubin is not water soluble ( fat
soluble)
Sickle cell is the most likely cause of unconjugated bilirubin amongst the
listed condition, massive hemolysis of RBC leads to high level of
unconjugated bilirubin
C. CASE STUDY 3
What is the clinical definition of diarrhea-Diarrhea is the increase in the
volume or frequency of defecation
Difference between large ansd small volume diarrhea
- Large volume diarrhea is small bowel diarrhea and small volume
diarrhea is large bowel diarrhea
- Small volume diarrhea has loose fecal matter with blood and mucus
while large volume contain bulky and undigested food in the fecal
matter
- No abdominal bloating in small volume but tenesmus is present : large
volume abdominal bloating present but no tenesmus
- Patients 1 (Kayexalate)-
- patient 2 ( cholera)- bacterial toxin increase luminal secretion via cAMP
production
 - Patient 3 (Diabetic)- usual due to celiac sprue, bacterial overgrowth,
fecal incontinence with anorectal dysfunction
- Patient 4( ulcerative colitis)- inflammation of the mucosal surface of the
bowel ; leading to the disruption of the tight junction of the mucosa and
increased permeability
-patient 5( crohns disease and multiple bowel resection)- maybe cause by
inflammatory(mucosal inflammation) and non -inflammatory causes e.g.
short bowel syndrome, lactose intolerance, bacterial overgrowth, ileal
dysfunction etc
D. CASE STUDY 5
Differentials of diarrhea in a woman with SLE
- Autoimmune enteropathy
- Crohns disease
- Ulcerative colitis