gastroenterology

A 45-year-old man presents to the emergency department with severe epigastric pain radiating to the back. He has a history of alcohol use disorder and has been drinking heavily over the past week. On examination, he is febrile, tachycardic, and has abdominal tenderness. Laboratory tests reveal elevated serum lipase and amylase levels. What is the most appropriate initial management for this patient?

A 64-year-old woman presents for follow-up after experiencing intermittent episodes of right upper quadrant colicky pain over the past year, which have since resolved. She denies any current pain, fever, jaundice, or changes in bowel habits. Physical examination is unremarkable, and recent liver function tests are within normal limits. An elective abdominal ultrasound was performed, yielding the image shown. Considering the clinical context and the findings demonstrated, what is the most appropriate next step in her management?

A 28-year-old male presents to the emergency department with severe abdominal pain, fever, and bloody diarrhea for the past 2 days. He has a known history of Crohn's disease, diagnosed 5 years ago, and has been managed with azathioprine. He admits to inconsistent adherence to his medication regimen over the past year due to feeling well. On examination, he is febrile (38.9°C), tachycardic (110 bpm), and hypotensive (90/60 mmHg). His abdomen is distended and tender to palpation, particularly in the lower quadrants, with guarding. Laboratory investigations reveal a white blood cell count of 18,000/mm³ with a left shift, hemoglobin of 10 g/dL, platelets of 450,000/mm³, albumin of 28 g/L, and C-reactive protein (CRP) of 150 mg/L. An abdominal X-ray shows dilated loops of bowel. Which of the following is the MOST appropriate next step in the management of this patient?

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 62-year-old presents with jaundice and RUQ pain. The image was obtained during ERCP. What is the MOST appropriate next step?

A 72-year-old woman presents with a long history of heartburn, regurgitation, and recently developed a chronic cough, particularly at night. Physical examination is unremarkable. A chest radiograph is obtained. Considering the radiographic findings in the context of the patient's presentation, what is the most likely pathophysiological mechanism contributing to her chronic cough?

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 63-year-old man presents with dysphagia and early satiety. His BMI is 21. A CT scan is performed. Based on the image, and assuming conservative measures have failed, what surgical approach is MOST appropriate?

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 68-year-old man presents to the emergency department with fatigue, pallor, and shortness of breath on exertion. His blood tests reveal a hemoglobin level of 7.5 g/dL, mean corpuscular volume (MCV) of 72 fL, and low serum ferritin. He has a history of osteoarthritis and takes ibuprofen regularly. What is the most likely cause of his anemia?

A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A 55-year-old woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Based on the clinical presentation and imaging findings, what is the most appropriate next step in management?

A 68-year-old male presents with a 2-day history of worsening left lower quadrant abdominal pain, fever (38.5°C), and nausea. He has a history of similar, milder pain episodes. Examination reveals left iliac fossa tenderness with guarding. Bloods show WCC 16, CRP 120. A CT scan is performed (image provided). Considering the clinical picture and the imaging findings, which of the following represents 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 markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue but no other symptoms. Liver function tests are within his baseline. Alpha-fetoprotein is 150 ng/mL (normal <10). The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, what is the most appropriate immediate next step in this patient's management?

A 72-year-old woman presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unintentional weight loss of 4 kg. She reports feeling increasingly tired. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable. Abdominal examination is soft, non-tender, with no palpable masses. Digital rectal examination reveals no palpable lesion. Blood tests show a haemoglobin of 108 g/L, MCV 78 fL, and ferritin 12 µg/L. A colonoscopy was performed, and the image provided was captured during the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, which of the following investigations is most crucial for determining the extent of disease and guiding definitive treatment planning within the multidisciplinary team framework?

A 70-year-old male presents with jaundice and abdominal distension. The provided image was obtained. What is the MOST likely underlying cause of the jaundice?

A 6-month-old baby has abdominal swelling and vomiting. An abdominal X-ray shows a 'double bubble' sign. What is the most likely diagnosis?

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most appropriate next step in management?

A 45-year-old male presents with intermittent abdominal pain and melena. He has multiple cutaneous hemangiomas. The provided image was obtained. What is the MOST likely underlying cause of the patient's presentation?

A 62-year-old male with cirrhosis presents for routine surveillance. AFP is elevated. The provided image was obtained. 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 64-year-old woman presents for an elective abdominal ultrasound. Several months ago, she experienced a few episodes of intermittent, moderate-to-severe right upper quadrant pain that resolved spontaneously within a few hours each time. She denies any associated fever, chills, nausea, vomiting, or jaundice during those episodes or currently. She has no significant past medical history other than well-controlled hypertension. On examination today, she is afebrile, her vital signs are stable, and her abdomen is soft and non-tender. Routine blood tests performed prior to the ultrasound, including full blood count, liver function tests (bilirubin, alkaline phosphatase, AST, ALT, GGT), amylase, and lipase, are all within their respective normal reference ranges. The provided image is a representative view obtained during her ultrasound examination. Considering the patient's history, current clinical status, and the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few weeks despite being compliant with his prescribed mesalamine. A CT scan of the abdomen and pelvis is performed, as shown. What is the MOST appropriate next step in management?

A 68-year-old woman presented to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Initial investigations showed a WCC of 14,000, total bilirubin 6.0, ALP 450, ALT 300. She was diagnosed with acute cholangitis and underwent urgent ERCP, during which the image was obtained. Following successful endoscopic stone extraction and significant clinical improvement with normalising inflammatory markers and liver function tests, what is the MOST appropriate next step in the long-term management of this patient's condition?

Mr. Arthur Jenkins, a 72-year-old retired accountant, presents to his GP complaining of a change in bowel habit over the past 4 months, now experiencing increased frequency and occasional loose stools mixed with some mucus. He also reports intermittent small amounts of bright red blood on the toilet paper, which he initially attributed to haemorrhoids. He denies significant weight loss or abdominal pain. His past medical history includes hypertension well-controlled on medication and osteoarthritis. On examination, his abdomen is soft and non-tender, and digital rectal examination is unremarkable. Routine blood tests, including FBE and LFTs, are within normal limits. A faecal occult blood test is positive. Given these findings, a colonoscopy is arranged. The image provided was captured during the procedure. Considering the patient's presentation and the findings observed during the colonoscopy as depicted in the image, what is the most appropriate immediate next step in the management plan?

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, which of the following represents the most appropriate next diagnostic step to guide management?

A 65-year-old male with Hepatitis C cirrhosis is undergoing routine surveillance. A liver lesion was identified on initial ultrasound, prompting a contrast-enhanced ultrasound study. Considering the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A 25-year-old man presents to the emergency department with severe abdominal pain that started around his umbilicus and has now localized to the right lower quadrant. He has nausea and has vomited twice. On examination, he has tenderness and guarding in the right lower quadrant. His temperature is 37.8°C, and his white blood cell count is elevated. What is the most likely diagnosis?

A 58-year-old male with cirrhosis presents for routine surveillance. His AFP is 8. A contrast-enhanced ultrasound 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 28-year-old female presents to her general practitioner with a 6-month history of intermittent abdominal pain, predominantly in the right lower quadrant. She describes the pain as cramping and associated with occasional episodes of non-bloody diarrhea. She denies fever, weight loss, or recent travel. Her past medical history is significant for well-controlled asthma, for which she uses an inhaled corticosteroid as needed. Physical examination reveals mild tenderness to palpation in the right lower quadrant, but is otherwise unremarkable. Bowel sounds are normal. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are within normal limits. Stool studies for ova and parasites, bacterial culture, and Clostridium difficile toxin are negative. Given her persistent symptoms, the GP refers her for further evaluation. A CT enterography is performed, and relevant images are shown. Based on the clinical presentation and imaging findings, which of the following is the MOST likely long-term complication this patient is at increased risk of developing?

A 25-year-old woman presents to the clinic with a 2-week history of abdominal pain and diarrhea. She reports that the pain is crampy and occurs mostly in the lower abdomen. She has also noticed some blood in her stool. She has no significant past medical history and is not on any medications. On examination, she has mild tenderness in the lower abdomen but no rebound tenderness or guarding. What is the most likely diagnosis?

A 72-year-old woman presents with iron deficiency anaemia and a 4-month history of intermittent lower abdominal pain and tenesmus. Colonoscopy was performed, and the image shows a finding in the sigmoid colon. Biopsies are pending but highly suspicious for malignancy. What is the MOST appropriate initial staging investigation?

A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a representative image is shown. What is the MOST appropriate next step in management?

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

A 65-year-old male presents with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical presentation and the provided imaging, what is the most appropriate timing for definitive surgical management?

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the findings demonstrated in the provided images, which of the following management approaches is most likely indicated?

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 32-year-old male with Crohn's disease presents with increased abdominal pain and diarrhea. Review the imaging. What is the MOST appropriate next step?

A 58-year-old male, on chronic immunosuppressants, presents with vague abdominal pain. The images are shown. What is the MOST likely causative organism?

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, but denies any current pain, jaundice, or fever. An abdominal ultrasound is performed, the image is shown. What is the MOST appropriate next step in management?

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 70-year-old male with cirrhosis secondary to NAFLD presents for routine surveillance. A new 3 cm lesion was found in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?