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david
64 yr old male comes to his physician with abdominal pain and blood with stools which he attributes to hemmorhoids he also complains of hematuria .Xray shows multiple lung nodules >USg abdomen shows no pathology in liver .What is the most likely site of primary pathology
1) Appendix
2) cecum
3)sigmoid
4 Kidney
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raji
hi,
i think its goodpasture's syndrome , presenting itself as nephritic syndrome with hematuria & glomerulonephritis due to antibodies directed against glomerular basement membrane& haemorragic pneumonitis in the lung with interstitial fibrosis.
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raji
i think the blood with stools attributed to haemorrhoids by patient himself is given just to divert u.hope this helped.
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shaf
Raji you are wrong .Good pasteurs syndromeis not in a choice .I think you need to nderstand question first .See pt has two problems 1 bleeding per rectum 2 hematuria
he has pain too .In addition he has some thing in lungs which is nothing but metastasis .Now the question is whether it is from kidney as he has hematuria orit is from gut as he has abdominal pain and hemato cheziaalso .But at the end thre is a big clue from usg that livr is freeof metastasis.if malignancy was in gut the common site of metastasis is liver ,It is unusual in gut malignancy to have liver free and metastasis in lungs ,Where as you know kidney can metastisize via renal veis and drop mes in lung without seeding liver .Saj is absolutely correct .i hope it helps and good pastuers could never give rise to such a clinical picture .but if you think iyt can I will appreciate if you explain it to all thanks .Good luck
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shaf
Raji you are wrong .Good pasteurs syndromeis not in a choice .I think you need to nderstand question first .See pt has two problems 1 bleeding per rectum 2 hematuria
he has pain too .In addition he has some thing in lungs which is nothing but metastasis .Now the question is whether it is from kidney as he has hematuria orit is from gut as he has abdominal pain and hemato cheziaalso .But at the end thre is a big clue from usg that livr is freeof metastasis.if malignancy was in gut the common site of metastasis is liver ,It is unusual in gut malignancy to have liver free and metastasis in lungs ,Where as you know kidney can metastisize via renal veis and drop mes in lung without seeding liver .Saj is absolutely correct .i hope it helps and good pastuers could never give rise to such a clinical picture .but if you think iyt can I will appreciate if you explain it to all thanks .Good luck
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raji
hi,
oops! sorry. i misleaded. i answered the q in a hurry. now i understand. thanks for ur explanation.
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shaf
dear raji take care and dont repeat this thing in your exam best of luck
