1. Case Presentation Mohammad Wazzan Ahmad Al Siari Supervised by : Dr. Hind Fallatah

2. History 25 Years old not known to have any medical illness admitted to the hospital complaining of diarrhea, loss of weight and poor appetite for 2 months. +ve : flushing -ve : SOB, Fever, Jaundice

3. Investigations CBC : Hg = 8 with low MCV and MCH WBC = 4 PLT = 200 Creatinine = 220

7. Findings suggestive of IBD : mouth ulcers, a skin rash, episcleritis, an anal fissure or fistula, the presence of visible or occult blood on digital examination, abdominal masses or abdominal pain Evidence of malabsorption : wasting, physical signs of anemia, scars indicating prior abdominal surgery Lymphadenopathy possibly suggesting HIV and TB infections Abnormal anal sphincter pressure or reflexes possibly suggesting fecal incontinence Signs of hyperthyroidism: Goiter, exophthalmos, lid retraction …etc.

9. Chronic Diarrhea Osmotic Gap High  Fecal Fat +ve  MalabsorptionMalabsorption Celiac Wipple Bacterial overgrowth Tropical sprue Pancreatic insufficiency Others -ve  Osmotic Lactose intolerance Normal Secretory Motility Inflammatory Infection Bacterial Parasitic Viral Autoimmune

10. Osmotic Gap Stool Osmotic Gap = 290 – [ 2 x (Na+K) ] Less than 50  Normal

11. IBS