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Lumen Biopsy 5 Mar Crohns vs tuberculosis.pptx

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Lumen Biopsy Rounds GE 2 13-02-2024
Personal details • Mrs KS • 32yr/M • R/o Patiala, Punjab • Informant – Self
Chief complaint Loose stools x 1 yr
Loose Stools • Watery to semisolid • 8-10 times per day • Non- Fowl smelling • Bloody – off and on
• H/o pain abdomen + - Off and on - Diffuse - Colicky - Not related to intake of meals - Not relieved by defecation
• No h/o vomiting • No h/o heartburn, chest pain, reflux • No h/o fever • H/o wt loss + 8 Kg over 2 yrs
Past history Personal history • No h/o T2DM, HTN, TB • No h/o major illness in the past. • No h/o major surgery in the past. • Non alcoholic, non smoker • Mixed diet • No h/o tobacco or drug abuse
Examination • Average built and nourishment • Vitals • BP 110/70 mmHg • PR 88/min • SpO2 99% on Room air • No pallor, icterus, cyanosis, clubbing, lymphadenopathy or edema
Systemic examination • GIT • PA soft • Non tender • Gall bladder not palpable • No evidence of free fluid in abdomen • Bowel sounds + • spleen was not palpable. • CNS • Conscious, alert, oriented to time, place and person • No focal deficit • RS • Normal vesicular breath sounds bilateral lung fields. • CVS • S1/S2 normal, no S3/S4/murmur.
Investigations Investigations 15/01/24 Investigations 15/01/24 Hb (g/dl) 14.6 ESR 13 TLC (/mm3 ) 5410 Hs CRP (mg/L) 3.22 DLC (N/L) 43/41 Fecal Calprotectin (mcg/g) 261 Plt (/mm3 ) 3.04L Mantoux No induration Urea/Creatinine (mg/dl) 12/0.62 CECT Abd Normal Na/K (meq/L) 136/4.7 T.Bil /Dir (mg/dl) 0.5/0.1 ALT/AST (IU/L) 23/25 ALP (IU/L) 137 U/L T.P/Alb (mg/dl) 8.4/4.3
UGIE (29/06/23)
Biopsy • Fragmented bits of mucosal tissue lined by gastric antrum type epithelium. The lamina propria shows moderate chronic inflammatory cell infiltrate . The is no atrophy, metaplasia, dysplasia, H pylori. • Impression – Antral gastritis
LGIE
Biopsy • Tissue is lined by colonic epithelium. Occassional crypt shows dilataion and cryptitis. Lining epithelium shows focal intraepithelial neutrophils. Lamina shows small epitheloid and histicytic granulomas with Langerhans giant cells. Lyphocytic cuffing is not seen. The lamina shows moderate chronic inflammatory cell infiltrate comprising of of lymphocytes, plasma cells and eosinophils • Muscularis mucosa normal • No AFB seen • Imp – Granuolmatous colitis
LGIE • Normal • Biopsy taken
• Unit Diagnosis Differentials – 1. Crohn’s Disease • Biopsy No – S-648/2024

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Lumen Biopsy 5 Mar Crohns vs tuberculosis.pptx

  • 1. Lumen Biopsy Rounds GE 2 13-02-2024
  • 2. Personal details • Mrs KS • 32yr/M • R/o Patiala, Punjab • Informant – Self
  • 4. Loose Stools • Watery to semisolid • 8-10 times per day • Non- Fowl smelling • Bloody – off and on
  • 5. • H/o pain abdomen + - Off and on - Diffuse - Colicky - Not related to intake of meals - Not relieved by defecation
  • 6. • No h/o vomiting • No h/o heartburn, chest pain, reflux • No h/o fever • H/o wt loss + 8 Kg over 2 yrs
  • 7. Past history Personal history • No h/o T2DM, HTN, TB • No h/o major illness in the past. • No h/o major surgery in the past. • Non alcoholic, non smoker • Mixed diet • No h/o tobacco or drug abuse
  • 8. Examination • Average built and nourishment • Vitals • BP 110/70 mmHg • PR 88/min • SpO2 99% on Room air • No pallor, icterus, cyanosis, clubbing, lymphadenopathy or edema
  • 9. Systemic examination • GIT • PA soft • Non tender • Gall bladder not palpable • No evidence of free fluid in abdomen • Bowel sounds + • spleen was not palpable. • CNS • Conscious, alert, oriented to time, place and person • No focal deficit • RS • Normal vesicular breath sounds bilateral lung fields. • CVS • S1/S2 normal, no S3/S4/murmur.
  • 10. Investigations Investigations 15/01/24 Investigations 15/01/24 Hb (g/dl) 14.6 ESR 13 TLC (/mm3 ) 5410 Hs CRP (mg/L) 3.22 DLC (N/L) 43/41 Fecal Calprotectin (mcg/g) 261 Plt (/mm3 ) 3.04L Mantoux No induration Urea/Creatinine (mg/dl) 12/0.62 CECT Abd Normal Na/K (meq/L) 136/4.7 T.Bil /Dir (mg/dl) 0.5/0.1 ALT/AST (IU/L) 23/25 ALP (IU/L) 137 U/L T.P/Alb (mg/dl) 8.4/4.3
  • 12. Biopsy • Fragmented bits of mucosal tissue lined by gastric antrum type epithelium. The lamina propria shows moderate chronic inflammatory cell infiltrate . The is no atrophy, metaplasia, dysplasia, H pylori. • Impression – Antral gastritis
  • 13. LGIE
  • 14. Biopsy • Tissue is lined by colonic epithelium. Occassional crypt shows dilataion and cryptitis. Lining epithelium shows focal intraepithelial neutrophils. Lamina shows small epitheloid and histicytic granulomas with Langerhans giant cells. Lyphocytic cuffing is not seen. The lamina shows moderate chronic inflammatory cell infiltrate comprising of of lymphocytes, plasma cells and eosinophils • Muscularis mucosa normal • No AFB seen • Imp – Granuolmatous colitis
  • 16. • Unit Diagnosis Differentials – 1. Crohn’s Disease • Biopsy No – S-648/2024