Question
A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:
The correct answer is
Ileocaecal tuberculosis
Ileocaecal Tuberculosis Diagnosis Explained
The patient's presentation strongly suggests Ileocaecal tuberculosis.
Clinical Findings Analysis
- Chronic Symptoms (6 months): Malaise, cough, alternating constipation/diarrhoea, and intermittent abdominal pain are indicative of a chronic inflammatory or infectious process.
- Systemic Symptoms: Malaise and cough suggest a systemic illness, common in tuberculosis.
- Gastrointestinal Symptoms: Alternating bowel habits and abdominal pain point towards bowel involvement, specifically in the ileocaecal region where absorption and motility changes are common.
- Physical Examination: A doughy abdomen and an ill-defined mass in the right lower quadrant (RLQ) are characteristic findings in ileocaecal TB due to bowel wall thickening and possible mesenteric lymphadenopathy.
- Age Group: While TB can occur at any age, it is relatively common in young adults.
Differential Diagnosis Evaluation
- Appendicular lump: Typically presents more acutely with fever and localized RLQ pain. Chronic malaise and cough are less common. The doughy feel is less typical.
- Carcinoma caecum: While causing an RLQ mass and altered bowel habits, it is rare in a 22-year-old patient. Chronic malaise and cough are less common presenting features compared to TB.
- Ovarian mass: Can cause an RLQ mass and abdominal distension, but less likely to cause significant malaise, cough, and specific bowel habit changes unless very large or complicated.
Conclusion
The combination of chronic systemic symptoms (malaise, cough), chronic gastrointestinal disturbances, and physical findings (RLQ mass, doughy feel) in a young adult makes Ileocaecal tuberculosis the most likely diagnosis.
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1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdo- men
3. Caecal perforation is a well recog- nized complication of this condi- tion
4. Intravenous Neostigmine is used for the treatment of this condition
Select the correct answer using the code given below : - Which of the following statements regarding Carcinoid tumour are correct?
1. Terminal ileum is the most common site for these tumours in the gastrointestinal tract
2. These tumors arise from Kulchitsky cells situated at the base of intestinal crypts
3. 5-Hydroxytryptamine is the most common vasoactive peptide produced by these tumors
4. Serum chromogranin A is a useful marker for disease recurrence
Select the correct answer using the code given below :
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