Login to your account
Don’t have an account?
Create a Free AccountInternal Medicine Flashcard Archive
An unusual cause of severe watery diarrhea
A 75-year-old man presented to the gastroenterology department with a 4-week history of severe watery diarrhea (at least 20 times a day) and appetite loss. He had been taking amlodipine 5 mg once daily for 12 years and olmesartan 20 mg once daily for 11 years because of hypertension. His vital signs were stable, and the abdominal examination was normal. He was neither anemic nor icteric. His body weight decreased by 5 kg during the last 1 month. Laboratory evaluation showed that serum creatinine level and serum uric acid level were elevated at 1.46 mg/dL (range 0.6–1.1) and 12.1 mg/dL (range 3.6–7.0), respectively.Vanishing tumor of the stomach
A previously healthy Japanese 36-year-old man presented to the gastroenterology department with a 2-day history of acute-onset severe epigastric pain after eating flounder sashimi. His vital signs were normal. Emergency endoscopy showed a submucosal tumor-like lesion with mild erosions in the upper body of the stomach (Fig. 1, Panel A). Further observation revealed a whitish linear worm penetrating the mucosa at the edge of the lesion (Fig. 1, Panels B and C). What is the diagnosis?An unusual cause of colitis
An 81-year-old Japanese woman presented to the author's department with acute abdominal pain and nausea. Laboratory evaluation showed a white-cell count of 13,270 cells/mm3 (Reference range, 3500–8500) and a C-reactive protein of 2.37 mg/dL (Reference range, 0.00–0.30). Non-enhanced computed tomography (CT) revealed calcification of mesenteric veins and thickening of the wall of the ascending and transverse colon (Fig. 1, Panel A). Colonoscopy showed edematous mucosa with erosions in the right hemicolon (Fig. 1, Panel B).A middle-aged woman with acute onset of fever, altered mental status, and movement disorder
A 60-year-old woman was admitted in the emergency room with acute onset of fever, altered mental status, and movement disorder. The patient had well-controlled type 2 diabetes mellitus with hemoglobin A1c up to 6.0%. In addition, neither steroids nor immunosuppressive agents had been taken. Brain magnetic resonance imaging (MRI) was shown in Fig. 1. What is the diagnosis?An elderly man with diarrhea and weight loss
A 77-year-old Japanese man presented to the author's department with diarrhea and weight loss (8 kg in the past 3 months). Vital signs were normal. Furthermore, abdominal examination was normal, and no skin lesions were observed. Esophagogastroduodenoscopy and total colonoscopy confirmed the absence of malignancy and inflammation; however, contrast-enhanced computed tomography revealed left inguinal lymphadenopathy. Laboratory evaluation showed white blood cell counts and serum lactate dehydrogenase (LDH) level were elevated at 16,500 /μL (range ≤8,500) and 272 IU/L (range ≤229), respectively.An unusual cause of intracranial hemorrhage
A 39-year-old woman with no significant medical history was admitted in the emergency room with loss of consciousness. Computed tomography revealed right-sided putamen hemorrhage (Fig. 1, Panel A). The patient had no risk factors for intracranial hemorrhage, including hypertension, older age, alcohol intake, and dyslipidemia. Cerebral angiography showed steno-occlusive changes at the terminal internal carotid artery (ICA) portion bilaterally, with the development of collateral circulation and no aneurysm (Fig.A middle-aged woman with microscopic hematuria detected at a medical check-up
A 56-year-old woman presented to the author's hospital with microscopic hematuria detected at a medical check-up. Vital signs were normal, and the patient had no symptoms. Laboratory evaluation showed that hemoglobin and serum creatinine levels were 12.1 g/dL and 0.74 mg/dL, respectively. Urine cytology confirmed no evidence of malignancy. Ultrasonography (USG) revealed compression of the left renal vein between the aorta and the superior mesenteric artery, with impaired blood outflow accompanied by distention of the distal portion of the vein (Fig.An elderly woman with progressive odynophagia, epigastralgia and nausea
An 84-year-old woman presented to the author's hospital with a 5-day history of progressive odynophagia, epigastralgia and nausea. These symptoms developed 3 days after taking an alendronate oral tablet (35 mg once-weekly) for the treatment of postmenopausal osteoporosis. The patient's other medication consisted of 10 mg/day of rivaroxaban for atrial fibrillation; 200 mg/day of cilostazol for lacunar infarction; 20 mg/day of esomeprazole and 300 mg/day of rebamipide for the prevention of peptic ulcer.A young man with acute onset epigastric pain after the ingestion of Japanese sushi
A 32-year-old man presented to the author's hospital with a 1-day history of acute onset epigastric pain after the ingestion of Japanese sushi (bite-sized pieces of cold cooked rice topped with fish, eggs, or vegetables and wrapped in seaweed). The patient had no medical history, and the patient's vital signs were normal. Emergency endoscopy revealed a whitish linear worm penetrating into the mucosa in the gastric corpus (Fig. 1, Panel A). What is the diagnosis?Exfoliative esophagitis
A 78-year-old woman presented to the author's hospital with epigastralgia. Vital signs were normal and the patient's abdomen was soft. The patient had taken dabigatran 110 mg twice daily due to atrial fibrillation for 2 years. Esophagogastroduodenoscopy (EGD) revealed longitudinal sloughing mucosal casts in the mid and lower esophagus (Fig. 1, Panel A and B).
The content on this site is intended for healthcare professionals.
Copyright © 2023 Elsevier Inc. except certain content provided by third parties.
