CPC-1385/12/10 Dr.Ahmad Khosravi Ghaem Hospital Mashad university.

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Irritable Bowel Syndrome (IBS)

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CPC-1385/12/10 Dr.Ahmad Khosravi Ghaem Hospital Mashad university

HX 17y male 17y male Chronic diarrhea Chronic diarrhea Abdominal pain (colicky) Abdominal pain (colicky) Low grade fever Low grade fever Anorexia Anorexia weight loss weight loss Dry couph Dry couph

PMH Dyspepsia(-) Dyspepsia(-) Hematemesis (-) Hematemesis (-) Melena (-) Melena (-) Hematochesia (-) Hematochesia (-) Jundice (-) Jundice (-) Cigarret,alcohol,opium(-) Cigarret,alcohol,opium(-)

PE Lean body weight Lean body weight Pale Pale PR= 90/min BP= 110/80 mm/Hg RR= 15/min T= 38° PR= 90/min BP= 110/80 mm/Hg RR= 15/min T= 38° Thyroid,Mucoses,Heart,Lung:N Thyroid,Mucoses,Heart,Lung:N LAP:(-) LAP:(-) Jundice:(-) Jundice:(-) Extrimity: N Extrimity: N CNS:N CNS:N

Abd. Examination Inspection:N Inspection:N Auscultation:N Auscultation:N Palpation:Mild diffuse tenderness without rebound Palpation:Mild diffuse tenderness without rebound No Organomegaly,mass,ascitis No Organomegaly,mass,ascitis TR:N TR:N Extrimity: N Extrimity: N CNS:N CNS:N

Lab.data WBC:11000 WBC:11000 P:82%,L:14%M:4% P:82%,L:14%M:4% Ht:29, Hb:10.6, MCV:77 Ht:29, Hb:10.6, MCV:77 ESR:55/1h ESR:55/1h SFe:52 mi.g SFe:52 mi.g TIBC:380mi.g /dl TIBC:380mi.g /dl Ferritin 35 mg/ml Ferritin 35 mg/ml S/E(OB+, OP-) S/E(OB+, OP-) U/A x 3NL U/A x 3NL PPD (-) PPD (-) ATTG (-), AEM Ab(-) ATTG (-), AEM Ab(-) FBS:95 mg/dl FBS:95 mg/dl Cr:0.6 mg/dl Cr:0.6 mg/dl Ca:8.6 mg/dl Ca:8.6 mg/dl P:4.1 mg/dl P:4.1 mg/dl Na:134 meq/l Na:134 meq/l K:3.3 meq/l K:3.3 meq/l Uric Acid: 6 mg/dl Uric Acid: 6 mg/dl LDH:240 LDH:240 CRP :+ + + CRP :+ + + LFT, PT:NL LFT, PT:NL TFT:NL TFT:NL HBSAg,HIV:Neg HBSAg,HIV:Neg Chol:86 mg/dl Chol:86 mg/dl TG:210 mg/dl TG:210 mg/dl

DD INFECTIONS: Tuberculosis,Amebiasis INFECTIONS: Tuberculosis,Amebiasis IBD AND ORTHER ENTERO COLITIS: Eosinophilic gastroenteritis IBD AND ORTHER ENTERO COLITIS: Eosinophilic gastroenteritis Chronic nongranolomatous ulcerative jejunoileitis Chronic nongranolomatous ulcerative jejunoileitis Radiation Colitis Radiation Colitis Collagenous, Lymphocytic Colitis Collagenous, Lymphocytic Colitis VASCULAR: Ischemic Colitis, vasculitis VASCULAR: Ischemic Colitis, vasculitis CELIAC SPRUE CELIAC SPRUE NEOPLASIA : Adenocarcinoma, Lymphoma, …. NEOPLASIA : Adenocarcinoma, Lymphoma, …. IBS IBS NSAID-induced injuries NSAID-induced injuries AMYLOIDOSIS AMYLOIDOSIS SARCOIDOSIS SARCOIDOSIS

Clinical diagnosis TB TB Crohn’ s disease Crohn’ s disease