Answer 26

 

- An answer emailed by Dr. Amira:

"..  السلام عليكم ورحمة الله وبركاته , 

As regard case 26 about 26 year-old male patient complaining of 4month duration of abdominal pain, vomiting, diarrhea, weight loss and tender hepatomegaly. I have noticed thickened intestinal wall in CT, so I think it is a case of Crohn's disease. CD is common in this age and it affects any part of GIT from mouth to anus so it can explain both upper and lower GIT manifestation in this patient, it is also associated by constitutional symptoms as malaise and weight loss. Occasionaly hepatosplenomegaly..."

Well done Dr.Amira

 

- Another Answer from Dr. Magdi Nagiub :

"..THE CASE: Male patient 26 years old complaining 4 months ago of abdominal pain, vomiting, diarrhea and significant weight loss with his examination revealed tender hepatomegally.

Differential Diagnosis:

- tender hepatomegally (infection, congesion and malignancy)

- Crohn's disease (abdominal pain, diarrhea, vomiting and weight, loss).

- it may be an infectious cause (acute hepatitis) but unnoticed to be feverish or jaundiced and uncommonly to be associated with significant weight loss. Other infections (e.g. gastroenteritis) with septicemia that causing tender hepatomegaly but the patient sought medical advice many times and this thinking mostly be minded and the patient received antibiotics without improvement.

- acute pancreatitis (but not for 4 months).

- specific infection (TB) but other criteria like fever not noticed but may be. but ??hepatomegally.

- malignancy (carcinoid) or intestinal lymphoma

- porphyrea

- Thyrotoxicosis (diarrhea, weight loss) but ?? abdominal pain and hepatomegally.

I think CT abdomen just showing hepatomegally and may be thickening of intestinal wall and this augment the suggestion of inflammatory bowel (Crhon's disease).

Finally thank you very much and hoping that you will not be upset of my poor thinking..."

Thank you Dr. Magdi but the last section of your discussion is the felicitous one.

 

The differential diagnoses were a lot, but the most accepted one is the Crohn's Disease since it can explain all the sufferings of the patient...please recheck the photo to see the increased bowel thickness (arrowed) in addition to the hepatomegaly, however he has responded well to the treatment of Crohn's disease.

 

 N.B. Click on photo to enlarge