gastroenterology

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most likely underlying cause?

A 38-year-old male presents to the emergency department with a 2-day history of intermittent abdominal pain, nausea, and vomiting. He reports passing dark, tarry stools. He has a known history of multiple cutaneous hemangiomas since childhood. On examination, his abdomen is distended and tender to palpation, particularly in the periumbilical region. Bowel sounds are hyperactive. Vitals are: HR 110 bpm, BP 100/60 mmHg, RR 20 breaths/min, SpO2 97% on room air, Temp 37.2°C. A CT scan of the abdomen and pelvis is performed, and a representative image is shown. Given the clinical presentation and imaging findings, what is the MOST appropriate initial management strategy?

A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. The provided imaging was obtained. What is the MOST appropriate next step in management?

A 64-year-old woman with a history of intermittent, self-resolving right upper quadrant pain presents for evaluation. She denies fever, chills, or jaundice, and her physical examination is unremarkable. Routine blood tests, including liver function tests and amylase, are within normal limits. An abdominal ultrasound was performed, and a representative image is shown. Based on the findings in this image and her clinical presentation, what is the most appropriate next step in management?

A 45-year-old male with Crohn's presents with persistent right lower quadrant pain. Stool studies are negative. Review the imaging. What is the MOST likely complication?

A 72-year-old male presents with increasing dyspnea. He has a history of GORD. The provided image was taken. What is the most appropriate next step?

A 6-week-old male presents with projectile vomiting after feeds. He is otherwise well-appearing, with normal vital signs and no abdominal distension. An ultrasound was performed, and an image is shown. What is the MOST appropriate next step in management?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 58-year-old male with known alcoholic cirrhosis undergoes surveillance. AFP is 600 ng/mL. The provided image was obtained. What is the next step?

A 3-year-old boy presents with intermittent abdominal pain and vomiting. Stool examination reveals a positive occult blood test. An ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 65-year-old male with new onset ascites and elevated ALP has the imaging shown. What is the MOST likely primary malignancy?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have since resolved. An abdominal ultrasound was performed, the image of which is shown. Liver function tests are within normal limits. Which of the following is the MOST appropriate next step in management?

A 35-year-old male with a history of multiple cutaneous vascular lesions presents with recurrent episodes of crampy abdominal pain and melena over the past month. His vital signs are stable. An abdominal CT scan is performed. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate next step in the management of this patient?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have resolved spontaneously. She denies any current pain, jaundice, fever, or changes in bowel habits. Her physical examination is unremarkable, with a soft, non-tender abdomen. Liver function tests are within normal limits. An abdominal ultrasound, as shown, was performed. Given the clinical context and the ultrasound findings, what is the MOST appropriate next step in management?

A 70-year-old male with ascending cholangitis undergoes ERCP. The image is obtained. What is the MOST appropriate next step in management?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 68-year-old male presents to his general practitioner with a three-month history of progressive dysphagia to both solids and liquids, accompanied by postprandial regurgitation. He also reports experiencing early satiety and occasional episodes of nocturnal coughing. His past medical history is significant for well-controlled hypertension and a remote history of smoking (quit 20 years ago). Physical examination reveals mild epigastric fullness, but is otherwise unremarkable. His vital signs are within normal limits. An abdominal CT scan with contrast was performed, and a representative image is shown. Given the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in the management of this patient?

A 58-year-old male with cirrhosis secondary to alcohol abuse presents for routine surveillance. His AFP is 25 ng/mL. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 35-year-old man presents with 3 weeks of anal pain after defecation, blood on wiping, and constipation (firm stool every 2-3 days). What is the likely diagnosis?

A 55-year-old woman presents with 24 hours of severe right upper quadrant pain, fever, and nausea. Examination reveals RUQ tenderness and a positive Murphy's sign. Vitals: T 38.5°C, HR 105, BP 130/80, RR 18, SpO2 98% RA. Labs: WCC 16, CRP 120, LFTs normal. An urgent abdominal CT is performed. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate definitive management strategy for this patient?

A 62-year-old male presents with jaundice and right upper quadrant pain. Initial labs show elevated bilirubin and alkaline phosphatase. An ERCP is performed, and the image is obtained. What is the MOST appropriate next step in management?

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. He reports occasional regurgitation of undigested food. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A 70-year-old presents with iron deficiency anaemia and intermittent rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but malignancy is strongly suspected based on the endoscopic appearance. What is the MOST appropriate next investigation to guide definitive management?

A 72-year-old male presents with fever, jaundice, and right upper quadrant pain. Investigations confirm acute cholangitis secondary to choledocholithiasis. He is taken for urgent ERCP. Following successful cannulation of the common bile duct and injection of contrast, the image is captured. Considering the findings visualised in the image, which of the following interventions is the most appropriate immediate next step to enable successful management of the underlying pathology during this procedure?

A 68-year-old presents with a 3-day history of fever, jaundice, and severe RUQ pain radiating to the back. Vitals: T 38.5°C, BP 110/70, HR 95. LFTs show bilirubin 150, ALP 450, ALT 120. An ERCP is performed for stone extraction. The image is captured during the procedure after cannulation. Considering the findings demonstrated in the image, what is the most appropriate immediate next step in management during the current procedure?

A 62-year-old male presents with a 3-month history of worsening upper abdominal pain, significant fatigue, and a 10 kg unintentional weight loss. His medical history includes long-standing peptic ulcer disease managed with proton pump inhibitors. On examination, he has mild hepatomegaly and trace ascites. Initial blood tests show elevated alkaline phosphatase and gamma-glutamyl transferase, with normal serum bilirubin and transaminases. A contrast-enhanced CT scan of the abdomen and pelvis is performed, and representative images are provided. Considering the clinical presentation and the findings demonstrated on the imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 62-year-old male with a history of hepatitis C presents with new onset jaundice and abdominal distension. Ascites is confirmed on examination. The patient denies alcohol use. An ultrasound with contrast is performed, as shown. What is the MOST appropriate next step in management?

A 55-year-old man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed. Considering the clinical context and the findings on imaging, what is the most appropriate next diagnostic step?

A 58-year-old male presents with acute onset LLQ pain, low-grade fever, and mild nausea. His vitals are stable. An abdominal CT scan was performed, the axial view is shown. What is the MOST appropriate initial management strategy?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is elevated. A CT scan of the abdomen with and without contrast is performed, as shown. What is the MOST appropriate next step in management?

A 32-year-old male presents to his general practitioner complaining of severe anal pain, especially during and after bowel movements. He also reports seeing bright red blood on the toilet paper. On examination, there is a visible tear in the anal mucosa at the 6 o'clock position. Which of the following is the MOST appropriate initial management strategy?

A 32-year-old woman presents to her general practitioner complaining of severe anal pain during and after bowel movements, along with bright red blood on the toilet paper. She reports constipation and straining during defecation. Examination reveals a visible longitudinal tear in the anal mucosa at the 6 o'clock position. Which of the following is the MOST appropriate initial management strategy, according to Australian guidelines?

A 68-year-old patient presents with chronic intermittent upper abdominal discomfort, postprandial fullness, and occasional regurgitation. Physical examination is unremarkable. A chest radiograph is performed as part of the workup. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate next step in management?

A 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. Considering the clinical context and the radiographic findings, what is the MOST likely underlying cause of this presentation?

A 72-year-old woman presents with a 2-day history of worsening right upper quadrant pain radiating to her back, associated with nausea and a low-grade fever. On examination, she is jaundiced and has tenderness in the right upper quadrant. Laboratory tests show a total bilirubin of 75 µmol/L, ALP 350 U/L, ALT 200 U/L, and WCC 13.5 x 10^9/L. An urgent ERCP is performed, during which the image is captured. Following successful endoscopic clearance and clinical improvement, which of the following is the MOST appropriate long-term management strategy?

A 33-year-old lady has an HNPCC gene mutation and two sisters with bowel cancer. She reports no change in bowel habits. What is the best surveillance for bowel cancer in this patient?

A 68-year-old male presents to his GP complaining of a change in bowel habit over the past 6 months. He reports increasing constipation alternating with episodes of diarrhea. He also mentions unintentional weight loss of approximately 5 kg during this period. He denies any family history of bowel cancer. A colonoscopy was performed, and a representative image is shown. Assuming the lesion is confirmed as malignant, what is the MOST appropriate next step in the management of this patient?

A 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. Considering the clinical context and the radiographic findings, what is the primary purpose of inserting a nasogastric tube in this patient?

A 62-year-old male presents with rectal bleeding and altered bowel habits. Colonoscopy findings are shown. What is the MOST appropriate next step?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with subjective fever and chills. He denies nausea, vomiting, or change in bowel habits. On examination, he is afebrile, heart rate 85 bpm, blood pressure 130/80 mmHg. Abdominal examination reveals tenderness in the left iliac fossa without guarding or rebound. White cell count is 14 x 10^9/L, CRP 80 mg/L. A CT scan of the abdomen and pelvis is performed, the relevant axial image is shown. Considering the patient's presentation and the findings on the provided image, which of the following represents the most appropriate initial management strategy?

A 45-year-old man presents to the emergency department with severe epigastric pain radiating to his back, which started suddenly a few hours ago. He has a history of alcohol use disorder and has been drinking heavily over the past week. On examination, he is diaphoretic and in distress. His vital signs show a blood pressure of 100/60 mmHg, heart rate of 110 bpm, respiratory rate of 22 breaths per minute, and temperature of 37.8°C. Laboratory tests reveal elevated serum lipase and amylase levels. An abdominal ultrasound shows no gallstones. Which of the following is the most appropriate initial management step for this patient?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history is significant for a recently diagnosed gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 65-year-old male with chronic hepatitis C cirrhosis undergoes routine surveillance imaging. He has no new symptoms. Liver function tests are stable. Alpha-fetoprotein is mildly elevated. The provided images are obtained. What is the most appropriate next step in management?

A 62-year-old male with a history of hepatitis C presents with new-onset right upper quadrant pain and a 5kg weight loss over the past 3 months. His liver function tests show elevated ALT and AST. An abdominal CT scan with and without contrast is performed (image attached). What is the MOST appropriate next step in management?

A 65-year-old male presents with acute LLQ pain. The provided image was obtained. What dietary advice is most appropriate upon resolution of acute symptoms?

A 62-year-old woman presents with right upper quadrant pain, fever, and jaundice. Initial labs show elevated bilirubin and alkaline phosphatase. An ERCP is performed, and the image is obtained. What is the MOST appropriate next step in management?

A 68-year-old man presents to his GP with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and a feeling of incomplete evacuation. He reports fatigue but denies significant weight loss. His physical examination, including digital rectal examination, is normal. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy is performed, and the image provided is a representative view from the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, what is the most appropriate immediate next step in the management of this patient?

A 68-year-old male with a history of GERD presents with worsening dysphagia and nocturnal cough. An X-ray is performed. Which of the following is the MOST likely underlying mechanism contributing to the patient's dysphagia?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed, as shown. Which of the following is the MOST appropriate next step in management?