Quiz 1

(Ref: Harrison 21st edition p 2475; Harrison 20th edition p 2265)

 Fecal calprotectin correlates with histological inflammation, predicts relapse and detects pouchitis. It is present in neutrophils and monocytes. Stool calprotectin is used to differentiate between diarrhea caused by IBD versus IBS.  Fecal lactoferrin is also used and is a marker for intestinal inflammation.

(Ref: Harrison 21st ed, p 2464; Harrison 20th ed, p 2253) Celiac disease patients have hypersensitivity to gluten present in cereals. Bread and pasta are made up of cereals and patient will develop diarrhea on intake of these products. The diagnosis is made on basis of antitissue transglutaminase antibody and small intestinal mucosal biopsy. Option d is ruled out as it is more common in developed counties. The leading cause of death in patients of celiac sprue is GI lymphoma.

(Ref: Harrison 20th edition, p 275; Harrison 19th edition, page 1891)
 Persistent calibre artery is called Dieulafoy's lesion. It is a large calibre arteriole that runs beneath the gut mucosa and bleeds via pinpoint mucosal erosion.
 For management of bleeding in Dieulafoy's lesion, endoscopic therapy like thermal coagulation or hand ligation is effective.
 In case of failure to control bleeding with above methods, angiographic embolization is used.
 Deep enteroscopy is used in patients with diffuse small bowel bleeding like vascular ectasia.

(Ref: Harrison 20th edition, p 2219; Harrison 19th p 1910)
 Esophageal rupture in Boerhaave syndrome is due to be the result of a sudden rise in intraluminal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to
relax. The syndrome commonly is associated with overindulgence in food and/or alcohol.
 The most common anatomical location of the tear in Boerhaave syndrome is at the left posterolateral wall of the lower third of the esophagus, 2-3 cm proximal to the gastro-esophageal junction, along the longitudinal wall of the esophagus.
 The second most common site of rupture is in the subdiaphragmatic or upper thoracic area.

(Ref: Grainger and Allison diagnostic Radiology: Sixth edition, Page 34)
 Normally the aortic arch and left main bronchus cause smooth external indentation of oesophagus.
 However in case of dysphagia lusoria since the patient has aberrant right subclavian artery originating from the left sided aortic arch, the vessel will have to reach the right axilla by crossing the oesophagus at oblique angle.
 The diagnosis is best made in the arterial phase of CT chest where the vessel reading is observed.
 Dysphagia aortica is due to compression of distal esophagus by ectasia or aneurysm of the descending thoracic aorta.

(Ref: Harrison 2016 edition, p 220; Harrison 19th p 237/532)
Plummer Vinson syndrome or Sideropenic dysphagia, presents in postmenopausal women as a triad of Post cricoid dysphagia from:
1. Esophageal webs,
2. Iron deficiency anemia with beefy-red tongue due to atrophic glossitis
3. Koilyonychia
It is a premalignant condition with increased risk of squamous cell carcinoma of esophagus.