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170 Cards in this Set
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Hamartomatous polyps in the in the colon, esophagus, stomach and coaselscing mucosal lesions in the buccal mucosa with "cobblestone" of the tongue
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Cowden's syndrome
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Cyanosis with normal oxygen saturation after using Hurricane/Benzocaine Spray before endoscopy.
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Methhemoglobinemia
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Fever, weight loss, costovertebral angle tenderness, microscopic hematuria, and isolated elevated ALP level with normal transaminases.
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Renal cell carcinoma
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Heart fibrosis and right heart failure with elevated chromogranin A.
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Carcinoid syndrome
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Pathergic skin lesion on lower extremity in a patient with ulcerative colitis.
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Pyoderma gangrenosum (originiates as a small tender papule on erythematous base)
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Diarrhea + Cruise Ship.
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Norwalk virus
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Necrolytic migratory erythema.
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Glucagonoma
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73-year-old with bony pain, weight loss, narrow anion gap, hypercalcemia, now presenting with upper GI hemorrhage and found to have gastric mass.
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plasmacytoma (with underlying multiple myeloma)
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Diarrhea + tropics + high MCV anemia.
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Tropical sprue
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"Plucked chicken skin" + GI bleeding. |
Pseudoxanthoma elasticum (PXE)-
Gastric bleeding is rare and is thought to arise from sub mucosal yellowish nodular lesions similar to xanthoma like skin lesions seen in the disease |
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Abdominal pain out of proportion to palpation with explosive maroon stools.
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Acute mesenteric infarction
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Dysphagia + cervical "shelf" on upper GI series.
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Crycopharyngeus "bar"
also known as cricopharyngeal muscle spasm/achalasia (non-specific finding) |
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Subepithelial gastric mass staining positive for CD117 (c-kit).
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Gastrointestinal Stromal Tumor (GIST)
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Sitophobia from meal-related dyspepsia + Weight Loss + Epigastric Bruit + Concave indentation on celiac trunk on angiography.
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Median arcuate ligament syndrome
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Crohn's disease with sharp CVA tenderness and hematuria.
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Oxalate stone
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Pancreatic cyst on CT with mucinous, gelatinous fluid from ampulla on endoscopy.
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Main branch intraductal papillary mucosal tumor (IPMN)
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Diarrhea + PAS-postive foamy macrophages on small intestinal biopsy + negative acid fast stain.
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Whipple's disease
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Diarrhea + PAS-positive foamy macrophages on small intestinal biopsy + positive acid fast stain.
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Mycobacterium avium intracellulare (MAC)
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HIV Diarrhea + Paresthsia in "saddle distribution".
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Herpes simplex nirus (HSV) proctitis
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HIV + Bloody Diarrhea + "Flask-Like Ulcers" on biopsy.
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Entomoeba histolytica
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HIV + Bloody Diarrhea + "Owl's Eyes" inclusions on biopsy.
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Cytomegalovirus (CMV) colitis
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Recurrent tongue swelling + fissured tongue + facial paralysis noncaseating granulomas of tongue + diarrhea.
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Melkersson-Rosenthal Syndrome (Orofacial Crohn's)
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Subepithelial gastric mass + 4th layer involvement + actin-positive + CD 117-negative.
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Leiomyoma
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Acute lower abdominal pain in the setting of a focal oval area of fat in anti-mesenteric border of the sigmoid colon on CT with a central attenuating line through the inflamed fat.
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Epiploic appendigitis
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Diarrhea + "congophilic angiopathy".
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Gastrointestinal amyloidosis
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Diarrhea + high MCV + low B12 level + high folate level.
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Small intestinal bacterial overgrowth (SIBO)
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Dyspepsia + thick gastric folds + foveolar hyperplasia.
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Menetrier's Disease
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High transferrin saturation + Kupffer cells infiltrated with iron + hepatocytes not infiltrated.
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Hemosiderosis from iron overload
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Isolated fundic varices in setting of chronic panceatitis.
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Splenic vein thrombosis
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Ascites + evevated bilirubin + hepatomegaly + bone marrow transplant within previous 3 weeks.
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Veno-occlusive disease (VOD) or Sinusoidal Obstructive Syndrome (SOS)
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Constipation with simultaneous incease in both rectal and anal leads on anorectal manometry.
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Dyssynergic defecation
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Hamartomatous polyps + protein-losing enteropathy + diarrhea + alopecia + dystrophic nails.
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Cronkhite-Canada Syndrome
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Weird Oral Projection + Globus + Dysphagia.
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Fibrovascular polyp of esophagus
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Gastric polyps with cystic dilatations of oxyntic gland mucosa in setting of PPI use.
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Fundic gland polyposis
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PAS-positive, diastase-resistant globule accumulated in hepatocytes.
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Alpha-1 antitrypsin deficiency
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Young woman with diarrhea, iron deficiency anemia, and low carotene.
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Celiac sprue
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High serum calcium + thick gastric folds + multiple gastric ulcers.
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Multiple endocrine neoplasia (MEN) type 1 (Werner's Syndrome)
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Recurrent biliary colic + elevated amylase + high +AST during symptoms + dilated common bile duct + no stones on ultrasound.
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Sphincter of Oddi Dysfunction (SOD) type 1
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Most likely diagnosis in a pregnant woman who turned yellow (yeah, that's all you get).
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Viral Hepatitis
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Vasculopath + Anemia + "Needle shaped cloefs" on mucosal biopsies of the colon.
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Cholesterol embolization to colon
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Hematemesis + Subcutaneous Air + Left-Sided Effusion.
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Boerhaave'e Syndrome
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Elevated gastric + low intragastric pH + hypertrophic parietal cell mass + negative secretin stimulation test.
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Antral predominant H. pylori infection
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Alopecia + Dystrophic Nails + Colon Polyps.
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Cronkhite-Canada Syndrome (I had to put this one twice!)
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HIV + Fever + Diarrhea + B12 Deficiency.
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Cryptosporidiosis with terminal ileal involvement
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Thick Gastric Folds + Diarrhea + Low Albumin + Protein Losing Enteropathy + Edema.
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Menetrier's Disease
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Black Velvety Rash + No Metabolic Syndrome + Early Satiety + Dyspepsia + Weight Loss.
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Gastric cancer withn acanthosis nigricans
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Ascites with a PMN count <250 but positive for E. coli.
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Non-neutrocytic bacterascites (NNBA)
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Recurrent Abdominal Pain + Family History of Abdominal Syndrome + Visceral and Peripheral Edema + Worsens with Enalapril.
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Hereditary angioedema
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Keratoderma of Palms and Soles + Dysphagia.
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Tylosis (Howell Evans Syndrome)
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Autosomal dominant
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AIDS + Jaundice + Cystic Blood-Filled Space on Liver Biopsy.
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Peliosis Hepatis (Bartonella henslae)
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Dyspepsia + Sheets of T Lymphocytes on Gastric Biopsies.
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Lymphocytic gastritis
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Biggest concern in a patient with high-volume lower GI bleeding in the setting of a previous abdominal aortic aneurysm repair.
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Aortoenteric fistual
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Biggest concern in a patient developing high-volume lower GI bleeding within hours of a diagnostic liver biopsy.
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Hemobilia
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Female + Monthly Abdominal Cramping + Colonic Subepithelial Nodule During Flares + No Nodule Between Flares.
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GI endometriosis
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Neutropenia + Right Lower Quadrant Abdominal Pain + Thickened Cecum on CT.
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Typhlitis
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Intermittent Vague Abdominal Pain + Bulbous Dilation of Ampulla on ERCP.
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Choledochocele (Type III choledochal cyst)
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Diarrhea + Erythematous Scaling Plaques on Legs and Face + Receiving TPN.
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Zinc deficiency
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Portal Hypertension + Eosinophilia + Normal liver Function Tests + Large Spleen.
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Schistosomiasis
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Recurrent small bowel obstructions in the setting of hypercalacemia.
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MEN-I with small bowel carcinoid
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Recalcitrant acid reflux symptoms post-Billroth II with markedly elevated gastrin levels.
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Retained antrum syndrome
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Cavernous Hemangioma on Mouth and Tongue + GI Bleeding + History of Intussusception.
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Blue Rubber Bleb Nevus Syndrome.
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History of Chronic Pancreatits + GI Bleed + Blood from Ampulla on Endoscopy.
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Hemosuccs pancreaticus
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Isolated Elevated ALP + Bad Headaches + Markedly Elevated ESR.
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Temporal arteritis
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36-year-old woman with chronic cough, bilateral hilar adenopathy, erythema nodosum and pancreatic head mass with dilated common bile duct in the setting of fevers and fatigue.
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Pancreatic sarcoidosis
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Diarrhea + Chocolate Milk
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Listeriosis
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Diarrhea + Reheated Rice
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Bacillus cerus
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Diarrhea + Undercooked Beef.
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Enterohemorrhagic E. coli
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Diarrhea + Raw Shellfish from Gulf Coast.
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Vibrio parahemolyticus or Vibrio vulnificus
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Patient on 6-MP for Crohn's Disease has leukopenia, markedly elevated 6-TG level, and low 6-MMP level.
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Low levels of TPMT
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Diarrhea + Stool Anion Gap=130 + Stool pH <6.
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Carbohydrate malabsorption
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Subepithelial Gastric Nodule + Actin and Vimentin-Positive Staining.
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Glomus tumor
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Subepithelial GAstric Nodule + S100-positive Staining.
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Schwanomma
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Subepithelial gastric nodule that is spherical, extramural and anechoic on edoscopic ultrasound.
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Duplication cyst
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Yellow + Panniculitis + History of Arterial Dissection.
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Alpha-1 antitrypsin deficiency
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Smoker + New-onset achalasia + Anti-Hu antibody.
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Paraneoplastic achalasia from lung cancer
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Recurrent giardiasis with virtually no plasma cells on mucosal biopsies of the proximal jejunum.
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Combined variable immunodeficiency (CVID)
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Interface hepatitis with a plasma cell infiltrate.
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Autoimmune hepatitis
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Diarrhea + ≥100cm of Terminal Ileum removed.
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Bile salt deficiency with fat malabsorption
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Jaundice and mental status changes at week 38 of pregnancy with elevated bilirubin, elevated INR, and low serum glucose.
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Acute fatty liver of pregnancy (AFLP)
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Abdominal pain and left pleural effusion 3 weeks after motor vehicle accident.
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Pancreaticopleural fistual
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Tumor from a 38-year old colon cancer is found to have microsatellite instability and to express MLH1 and MLH2. There is ann extensive family history of colon cancer.
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Hereditary nonpolyposis colorectal cancer (HNPCC)
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Dysphagia + "Megaduodenum" on barium study.
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Systemic sclerosis
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Dysphagia + Living Under a "Thatched Roof Hut".
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Chagas disease
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Recurrent Pancreatitis + Elevated IgG-4.
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Autoimmune pancreatitis
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Abdominal Pain + Positive "Carnett Sign".
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Myofascial abdominal wall pain
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Angular Stomatitis + Glossitis + Seborrheic Dermatitis + Visual Changes + Cheilosis
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Pyriodoxine (vitamin B6) deficiency
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Diarrhea + Dermatitis + Dementia.
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Niacin deficiency
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TPN + Night Blindness + Tachycardia + Vomiting + Recurrent Headaches + Shortness of Breath.
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Molybdenum deficiency
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Young patient from Mediterranean region with a recent Campylobacter infection who now has a lyphopasmacytic inflitrate in the small intestine and a heavy chain paraproteinemia.
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Immunoproliferative small intestinal disease (IPSID)
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TPN + Heart Failure + Myositis.
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Selenium deficiency
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Chronic Diarrhea + Pruritic Rash on Extensor Surfaces of Arms.
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Celiac sprue with dermatitis herpetiformis
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Young male from Turkey with intermittent bouts of overwhelming abdominal pain, elevated ESR, and a family history of the same.
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Familial Mediterranean Fever (FMF)
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Severe Bloody Diarrhea + Discreet Ulcers in Colon + Ingested Erythrocytes in Motile Trophozoites on mucosal biopsy.
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Entomoeba histolytica
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Large voulme watery diarrhea + Hypokalemia + Achlorhydrian + Pancreatic mass.
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VIPoma
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Recurrent abdominal pain + Blistering of hands + Neuropsychiatric history.
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Porphyria
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Positive Rheumatoid Factor + Lower Extremity Purpuric Rash + Paresthesias + Hepatitis C.
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Cryoglobulinemia
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Small Bowel Obstruction + "Cafe au lait" Macules + Axillary Freckles.
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Neurofibromatosis
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A 30-year old with chronic recalcitrant constipation and intermittent fecal impaction fails a ballon expulsion test and, on barium enema, has a normal-size rectum but severely dilated sigmoid colon.
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Adult Hirschprung's disease
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Acute Bloody Diarrhea + Fever + Thrombocytopenia + Renal Insufficiency + Rash.
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E. coli 0157:H70 with HUS-TTP
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Angioid Streaks in Eyes + Isolated Elevated ALP.
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Paget's disease
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Fulminant Liver Failure + Markedly Depressed ALP.
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Wilson's disease
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Health freak + Elevated liver tests + Lipid-filled stellate cells on liver biopsy.
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Vitamin A overdose
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Flushing with alcohol ingestion + Intermittent hypotension + Darier's Sign + Abdominal pain + Malabsorption + Hepatoslpenomegaly + Elevated ALP (this has to be something! )
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Mastocytosis
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Critically ill patient + Fever + Elevated amylase + Thick gallbladder wall on ultrasound but no stones + Positive Murphy's sign.
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Acalculous cholecystitis
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Teenager with recurrent abdominal pain in the setting of chronic renal insufficiency, arthralgias, and intermittent rash over buttocks and lower extremities.
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Henoch-Schonlein purpura
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Teenager with recurrent abdominal pain, diarrhea, and colitis in the setting of asthma.
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Churg-Strauss syndrome
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Diabetes + Gallstones + Weight loss + Steatorrhea + Pancreatic mass.
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Somatostatinoma
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Torrential upper GI hemorrage in setting of enlarged atria and quinidine use.
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Pill esophagitis with erosion into atrium
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Dysphagia + Right subclavian artery aberrantly arising from left aortic arch.
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Dysphagia lusoria (ie, aberrant right subclavian artery compressing the esophagus)
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Vitiligo + Hypergastrinemia.
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Pernicious anemia
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Weight loss + "Double duct sign" on ERCP.
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Pancreatic anemia
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History of gallstones + Recurrent cholecystitis + Small bowel obstruction at ileocecal valve.
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Gallstone ileus
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Young woman + Liver mass with central stellate scar on CT.
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Focal Nodular Hyperplasia (FNH)
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Diabetes + Dermatitis + Diarrhea + Weight loss + Pancreatic Mass.
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Glucagonoma
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Elderly patient with asymptomatic pearly white papules through-out the esophagus that are negative for hyphal forms.
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Esophageal glycogenic acanthosis
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ICU patient with obstruction and abdominal distenstion, CT reveals no evidence of obstruction but demonstrates a cecal diameter >10cm.
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Ogilve's syndrome
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Pancreatic cysts + Retinal angiomatosis + CNS hemangioblastoma.
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von Hippel Lindau disease
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Hepatitis C + Purple, polygonal, pruritic papules on lower extremities.
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HCV related lichen planus
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Patient with cirrhosis develops blistering skin lesions and septic shock after eating seafood.
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Vibrio vulnificus
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Sudden onset of seborrheic keratoses in elderly patients with recent unintended weight loss.
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Colon cancer with sign of Lesser Trelat
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AIDS patient on PPI's for dyspepsia has recalcitrant esophageal candidiasis despite two courses of fluconazole.
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Inadequate fluconazole absorption from PPI-induced hypochlorhydria
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Teenager with lifelong diarrhea + Contraction alkalosis + High chloride concentration in stool.
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Congenital chloridorrhea
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Young man with recurrent bouts of vomiting for years and migraine headaches in the setting of marijuana use.
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Cyclical vomiting syndrome (CVS)
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Teenager with recurrent abdominal pain, jaundice, and an abdominal mass, with an ERCP revealing a cystic dilatation of the intraduodenal portion of the common bile duct.
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Type III bile duct cyst (choledochocele)
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Diarrhea + Pet turtle.
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Salmonella
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"Stepwise"fever + Abdominal pain + Temperature-pulse dissociation + "Rose spots" on trunck and abdomen.
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Typhoid fever (Salmonella typhil)
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HBsAg(+), HBsAb(-), HBeAg(-), HBeAb(+), HBV DNA>10ƽ
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Hepatits B pre-core mutant
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Mostly likely diagnosis in patient with AIDS, CD4<200, with discreet elongated mid-esophageal ulcer that is negative for HSV, CMV, and Candida on brushing and biopsy.
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Idiopathic esophageal ulcer (IEU)---- likely HIV itself
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Patient with celiac spruehas persistent diarrhea despite compliance with diet and reversal of small bowel Marsh lesions.
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Comorbid microscopic colitis (Oher differential=lymphoma, true "refractory sprue")
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Diarrhea after terminal ileal surgery with <100 cm removed.
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Bile salt diarrhea
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Polyposis + "3-2-1 Rule" positve on family.
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Hereditary nonpolyposis colorectal cancer (HNPCC)
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Asian immigrant + Recurrent pyogenic cholangitis + Intra- and extrahepatic stone disease + Diffuse bile duct dilatations and strictures.
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Recurrent pyogenic cholangitis (Oriental Cholangiohepatitis")
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Elevated transaminases + Arthritis in 2nd and 3rd MCP joints.
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Hereditary hemochromatosis
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Swimming in Lake + Elevated ALP/TB + Temperature-pulse dissociation.
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Leptospirosis
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Recurrent bloody diarrhea after ileostomy that omproves with short chain fatty acid enemas.
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Diversion colitis
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Young patient + Ataxia + Chronic diarrhea + Low serum carotene + Lipid-containing vacuoles in enterocytes on small bowel biopsy.
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Abetalipoproteinemia
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Severe pruritis at week 30 of pregnancy with elevated serum bile acid levels.
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Cholestasis of pregnancy
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Patients with Crohn's Disease has hard, painful, inflamed lumps with pus drainage under armpit.
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Hidradenitis suppurativa from underlying Crohn's Disease
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Patient with chronic obstuctive pulmonary disease is found to have a submucosal rounded mass in the sigmoid colon during screening colonoscopy. The mass is biopsied and subsequently "deflates" and nearly disappears.
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Pneumatosis Cystoides Intestinalis
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Steatorrhea + Gastroparesis + Enlarged Heart + Perhipheral Neuropathy + Liver Test Abnormalities.
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Amyloidosis
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Patients with long-standing early satiety and nausea but no weight loss. Endoscopy reveals extrinsic compression of second part of duodenum. CT reveals enlarged head of the pancreas without a focal mass.
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Annular pancreas
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Dysphagia + Erythematous Scaling Lesions on Knuckles + "Shawl Sign" on Nape of Neck.
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Dermatomyositis
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Patient is admitted for pancreatitis. You give Compazine (prochlorperazine) for recurrent nausea and vomiting. Within 30 minutes, the patient develops a high fever, altered mental status, and becomes stiff as board.
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Neuroleptic Malignant Syndrome from Compazine (prochlorperazine)
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Paroxysmal and terrible anorectal pain that lasts seconds, and then is gone. Rectal exam and colonoscopy are normal.
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Proctaligia fugax
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Nausea + Vomiting + Kidney Stones + Constipation + Muscle Aches + Weakness + Depression.
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Hypercalcemia
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Intermittent epigastric pain always accompanied by shrtness of breath and diaphoresis. Epigastric pain usually triggered by exertion.
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Cardiac angina with radiation to the epigastrium
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Elevated ALP/GGT + Normal AST/ALT + Normal bilirubin + Morning stiffness in hands + Subcutaneous nodules along forearms.
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Rheumatoid arthritis
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Colon Polyps + Epidermoid Cysts + Supernumerary Teeth + Osteoma.
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Gardner's syndrome
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Premature graying + vitiligo + positive Rhomberg sign + elevated gastrin.
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Perninious anemia
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Rheumatiod arthritis + splenomegaly + neutropenia + nodular regenerative hyperplasia + portal hypertension.
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Felty's syndrome
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Recent constipation + Strep bovis endocarditis.
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Colon cancer
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Patient with bloody diarrhea receives empiric antibiotics for presumed infectious colitis. The platelet count and hemoglobin subsequently fall and the creatinine rises. The patient has altered mental status and progressive fever.
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Antibiotic-precipitated HUS-TTP
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Low serum protein + Diarrhea + Focal white spots throughout small bowel mucosa.
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Intestinal lymphangiectasia
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Alcoholic + Ataxia + Tachycardia + Acidosis.
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Thiamine deficiency
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Diarrhea + Dysmotility + Heart Failure + Orthostatic Hypotension.
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Gastrointestinal amyloidosis
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HIV + Diarrhea + Eosinophilia + Developing Country + Charcot + Leyden crystals in stool.
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Isospora belli enteritis
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Superficial Migratory Thrombophlebitis + Depression + Abdominal Pain.
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Trousseau's sign and depression from underlying pancreatic cancer
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Recurrent Abdominal Pain + Recurrent Blistering on Dorsa of hands + Hypertrichosis.
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Variegated porphyria
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Iron Deficiency Anemia + Esophageal Web.
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Plummer-Vinson Syndrome
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Na + ↓K + ↓C1+ HC03 + BUN + Recurrent Vomiting.
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Gastric outlet obstruction
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Pharyngeal dysphagia in an elderly patient with osteoarthritis and a history of repetitive traumatic neck injuries.
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Cervical osteophyte
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Dysphagia + History of Eczema + "Rings" in Esophagus on Endoscopy.
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Eosinophilicv esophagitis
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Woman on oral contraceptivesn has subcapsular hepatic mass on CT.
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Hepatic adenoma
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Essential thrombocytosis + Elevated ALP/GGT + Multiple hypodense nodules in liver on CT.
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Nodular regenerative hyperplasia (NRH) of the liver
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Chronic diarrhea with stool anion gap >100 and stool pH<5.
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Carbohydrate malabsorption (eg, lactase deficiency, chewing gum diarrhea
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Cholestasis + "Florid Duct Lesion" with Granulomas + Ductopenia.
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Primary biliary cirrhosis (PBC)
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A 22-year-old with recurrent abdominal pain undergoes upper endoscopy which reveals focal patches of erythema. Biopsies are negative for H.pylori. His ESR and CRP are elevated
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Crohn's Disease with gastric involvement
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Technically challenging colonoscopy +Fecal white patches with clear spaces on biopsy.
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Pseudolipomatosis (insufflation artifact)
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Apthous ulcers in mouth and terminal ileum + Genital ulcer.
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Bechet's Disease
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Joint hypermobility + Splanchnic Aneurysms + Recurrent abdominal pain.
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Ehlers-Danlos Syndrome
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