Posted February 26, 200916 yr Patient, 30 year old male of Finnish descent admitted after complaining of repeated diarrhea, particularly watery stools. On examination, his abdomen appears distended. The spleen and liver could not be palpated. Patient appears to have a lot of bruising and reports that the bruises have been there for a while already. Edema in the legs were noticed and full laboratory workup was ordered. The results were as follows: Low hematocrit Elevated WBC count Hypocalcemia Low albumin Elevated Prothrombin time Normal platelet count. RBC appeared normal in size but lighter in color. Patient reports that he has difficulty exercising due to fatigue. Sample of stool from diarrhea was taken and found to be negative for occult blood and positive for fat. Small intestinal biopsy revealed loss of intestinal villi and crypt hyperplasia. Differential diagnosis?
February 26, 200916 yr Patient, 30 year old male of Finnish descent admitted after complaining of repeated diarrhea, particularly watery stools. On examination, his abdomen appears distended. The spleen and liver could not be palpated. Patient appears to have a lot of bruising and reports that the bruises have been there for a while already. Edema in the legs were noticed and full laboratory workup was ordered. The results were as follows: Low hematocrit Elevated WBC count Hypocalcemia Low albumin Elevated Prothrombin time Normal platelet count. RBC appeared normal in size but lighter in color. Patient reports that he has difficulty exercising due to fatigue. Sample of stool from diarrhea was taken and found to be negative for occult blood and positive for fat. Small intestinal biopsy revealed loss of intestinal villi and crypt hyperplasia. Differential diagnosis? eating to many hot wings at the bar! amirite?
February 26, 200916 yr Author eating to many hot wings at the bar! amirite? no u not rite Doesn't explain any of the symptoms except possibly the diarrhea.
February 26, 200916 yr fat in stool, doesnt want to exercise? this nigga has been drinking to much beer and munching on delicious hot wings. case closed edit: edema in the legs is cause by the excess fat intake. Edited February 26, 200916 yr by ian48065
February 26, 200916 yr Author fat in stool, doesnt want to exercise? this nigga has been drinking to much beer and munching on delicious hot wings. case closed edit: edema in the legs is cause by the excess fat intake. Fat is absorbed in the intestines regardless of whether or not a person exercised. If fat was not absorbed and literally went in one end and out the other, he'd be losing weight, if anything. Edema is caused by excess accumulation of interstitial fluid and has nothing to do with fat intake.
February 26, 200916 yr Author Jedi Pimp;612156']I'm gonna use the guys home video footage and say that this was cause for 95% of his reported problems. The other 5% is GRIDS http://tunteella.xerc.biz/dump/00020046.gif http://tunteella.xerc.biz/dump/00020258.jpg rifk
February 26, 200916 yr Author sideways;612180']BITCH HAS A WEIRD DISEASE FROM AFRICA MIXED WITH IBS IBS only explains the diarrhea, and even then, doesn't fit well. IBS wouldn't cause the appearance of fat in stools (steatorrhea). Also, it doesn't explain any of the laboratory values or any of the other symptoms. New rule just like on House when it comes to these cases on here... It's not GRIDS, it's never GRIDS. Also, no fever so it's not infection.
February 27, 200916 yr Author could be liver pathology LFT results? also any pain reported by patient? Patient reports painful abdominal distension. Liver pathology isn't a bad differential, to be honest, low albumin and elevated INR along with abdominal pain are symptoms of a liver condition. However, physical exam could not palpate liver, indicating no enlarge liver. Also, patient did not appear jaundiced or exhibit asterexis. Liver function tests reveal elevated ALT and AST levels, but not high enough to be conclusive for hepatic inflammation. Hepatitis A, B, and C RNA tests are negative.
February 27, 200916 yr Author Also, abdominal distension does not appear to be due to ascites fluid buildup in the peritoneum. It's not due to portal vein hypertension.
February 27, 200916 yr Author Oh come on, noone wants to venture a differential? If noone gets in the next few hours, I'll post the diagnosis, but that's not as fun.
February 27, 200916 yr as i have stated many times above /\ here is your answer : http://southflorida.metromix.com/content_image/full/311804/560/370 and this explains why he cant / wont exercise.. its because he is too tired from this : http://www.jonco48.com/blog/white_20man_20chciken.jpg gg mr. house it was a well fought match.
February 27, 200916 yr He's a hemophiliac and was injuied internally in the stomach region. Easy as pie everyone.
February 27, 200916 yr Author He's a hemophiliac and was injuied internally in the stomach region. Easy as pie everyone. Not a bad idea, only internal injuries severe enough to cause low hematocrit would present with a peritoneal hematoma, which this person did not exhibit. Also, patient denies any sort of recent trauma. Bruises came from trauma that occurred a long time ago, and claims that none of those injuries in the past were ever that severe. Hemophilia is a possible explanation for the ease of bruising and elongated PTT time. However, it doesn't explain any of the other symptoms. One final bit of workup: The stool samples were analyzed further and found that there was even the presence of glucose in the stool. What would cause a person to have symptoms resembling hemophilia, severe diarrhea, anemia, and the presence of fat and sugars in the stool?
February 28, 200916 yr It's not lupus! It's never lupus. TAKE MY FUCKING DIAGNOSIS INTO CONSIDERATION YOU STUPID PIGGY FUCK!
February 28, 200916 yr Author I'm disappointed, you didn't try really hard on this case. It's not even that rare of a disease either. It's an autoimmune disease called Celiac Sprue. Autoimmune disease where your body's immune system attacks the villi of your duodenum and jejunum, resulting in the inability to absorb nutrients such as sugar and fat, which is why the patient had the above mentioned nutrients found in his stool. Also, the duodenum is responsible for absorbing iron, so his inability to absorb iron results in low hematocrit and anemia. Hypocalcemia is due to inability to absorb calcium, which also occurs in the duodenum. Elevated prothrombin time and ease of bruising is due to inability of the body to absorb Vitamin K, which is a necessary vitamin in the processing of clotting factors VII, X, IX, and prothrombin. Finally, the pathology report of destruction of the villi along with hypertrophy of the intestinal crypts are consistent with the diagnosis.
February 28, 200916 yr I'm disappointed, you didn't try really hard on this case. It's not even that rare of a disease either. It's an autoimmune disease called Celiac Sprue. Autoimmune disease where your body's immune system attacks the villi of your duodenum and jejunum, resulting in the inability to absorb nutrients such as sugar and fat, which is why the patient had the above mentioned nutrients found in his stool. Also, the duodenum is responsible for absorbing iron, so his inability to absorb iron results in low hematocrit and anemia. Hypocalcemia is due to inability to absorb calcium, which also occurs in the duodenum. Elevated prothrombin time and ease of bruising is due to inability of the body to absorb Vitamin K, which is a necessary vitamin in the processing of clotting factors VII, X, IX, and prothrombin. Finally, the pathology report of destruction of the villi along with hypertrophy of the intestinal crypts are consistent with the diagnosis. I threw a few of those symptoms in google yesterday and got Celiac's, I just assumed that you would've gone for something more uncommon :/
