A 17- Year- Old Boy with Biliary Obstruction. CC. HPI- 17 months prior to admission to MGH. Symptoms: Bloody diarrhea admission to a hospital what exams to do?. LAB. Serum aspartate aminotransferase level: 75 U/l Test for Clostridium difficile: positive
Symptoms: Bloody diarrhea admission to a hospital
what exams to do?
had not taken antibiotics before!
One month course of metronidazole
patient feels well
admission to a hospital
5d. Before admission
Alanine aminotransferase (U/l)
Aspartate aminotransferase (U/l)
Alkaline phosphatase (U/l)
Suggesting presence of pneumonia
of the right lower lobe
Various pain medications are
transfer to MGH
what to do?
His immunizations are up to date
and include viral hepatitis B
No family history of inflammatory
bowel disease or rheumatic disorders
lost 3kg in weight during the preceding two weeks
Temp.: 37.8 °C
Pulse : 85
BP : 120/55 mm Hg
Resp. : 20
White-cell count (per mm3)
Differential count (%)
Platelet count (per mm3)
Prothrombin time (sec)
Partial-thromboplastin time (sec)
The patient is a 17-year-old boy,who
suffers from epigastrical pain and
intermittently from diarrhea (even
bloody in the past).
Moreover there is evidence of biliary
Bilateral prominence of the interstitial
Ranitidine, clarithromycin and
acetaminophen are given
Temp. rises to 39.7 °C
CT of the abdomen and pelvis after
oral and iv. administration of
The patient´s clinical course and the result
of the limited testing that was performed
make it very improbable that the illness
has an infectious cause.
=>both are common in inflammatory bowel disease
The expanded portal tract (arrows) contains a duct surrounded by edema (arrowheads)
The pericuctal edema (arrow) results in an onionskin appearance.
There is no inflammation at the interfaces of the portal tracts and
Specimen of the Gastric Fundus. There is a granulomatous
reaction around a damaged gastric gland (arrows).
Specimen of the Duodenum. The central duct is acutely inflamed
and ruptured and is surrounded by acute and chronic
Primary sclerosing cholangitis
associated with Crohn`s disease.