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A 14-month-old boy with chronic abdominal distention, vomiting, and diarrhea was found to have tuberculosis (TB) in his gastrointestinal tract. TB usually affects the lungs but it can also affect other parts of the body. His mother was found to have TB in her lungs, probably because she traveled to other countries and was taking corticosteroid drugs to treat ulcerative colitis.

A 50-year-old man with liver disease was diagnosed with a parasitic infection called fascioliasis. In Europe, this parasite is most commonly associated with contaminated watercress. This patient had eaten watercress about three months before his symptoms began.

A 17-year-old boy was diagnosed with Crohn's disease and primary sclerosing cholangitis. Crohn's disease affects the intestines and primary sclerosing cholanitis affects the liver and biliary tract.

A two-day-old baby with persistent hypoglycemia despite treatment was diagnosed with diffuse islet-cell hyperplasia. Islet cells are the pancreatic cells that produce insulin, and hyperplasia means there were more cells than normal. This would cause excess production of insulin, which would cause hypoglycemia.

A Filipino woman traveling in the US was hospitalized with chronic fever. She was found to have typhoid fever and was treated with fluoroquinolone.

A 17-year-old girl who developed fever, abdominal pain, and diarrhea three weeks after a cesarean delivery was found to have a Salmonella infection in her large intestine. The species was Salmonella newport, which is a common cause of food poisoning.

A 45-year-old woman with a history of type 2 diabetes and a painful, swollen foot was diagnosed with pyoderma gangrenosum caused by Crohn's disease. Pyoderma gangrenosum is a skin disease that is commonly associated with inflammatory bowel disease.

A 17-year-old girl with jaundice and weight loss was diagnosed with liver damage caused by 3,4-methylenedioxy-methamphphetamine (MDMA), a drug commonly known as ecstasy. Jaundice is a yellowing of the skin and mucous membranes caused by liver damage.

A 13-year-old boy was admitted to a hospital with abdominal pain and swelling of the penis and scrotum. A CT scan of his abdomen was unable to find anything that could cause the genital swelling. However, a biopsy of his scrotum showed abnormalities called granulomas. Imaging of the gastrointestinal tract showed evidence of inflammatory bowel disease. He was diagnosed with Crohn's disease that had spread to his genitals.

A 17-year-old boy was admitted to a hospital with a history of weight loss and obstructive jaundice. Obstructive jaundice is a yellowing of the skin and eyes due to liver disease. In his case, diagnostic imaging tests revealed an inflammation of the pancreas, gallbladder, and biliary tract. He also had gallstones. He was eventually diagnosed with primary sclerosing cholangitis, which is an inflammation of the gallbladder and bile ducts.

A 74-year-old man was admitted to a hospital because of jaundice, which is usually a sign of liver disease. He tested positive for the hepatitis C virus, which he probably contracted when he received dialysis for kidney failure 10 years before. At that time, he received a kidney transplant. Tests also revealed that he had cryoglobulins in his blood. This is a common complication of hepatitis C. However, he had no sign of chronic liver disease. A liver biopsy showed that he had fibrosing cholestatic hepatitis, which is a form of viral hepatitis.

An 82-year-old woman was admitted to a hospital with kidney failure and a Staphylococcus aureus infection. She had a history of diabetes, coronary artery disease, and a stroke. A chest X-ray and CT scan showed that she had lung disease. Since this could not be related to her pre-existing diseases, it was considered a new disease. Her doctors considered miliary tuberculosis, which is a form of tuberculosis that can affect other organs besides the lungs. This was confirmed by a liver biopsy.

A 16-year-old boy was admitted to a hospital with recurring abdominal pain. He had suffered from recurring abdominal pain since the age of four. His parents were originally from Turkey and his older brother also suffered from abdominal pain. An abdominal X-ray showed intestinal blockage and other symptoms led his doctors to consider familial Mediterranean fever. This genetic disorder affects Jews, Arabs, Turks and Armenians. The gene mutation results in an abnormal protein in immune cells called neutrophils. The end result is an abnormal activation of the inflammatory response. The patient and his family declined treatment.

A 57-year-old man was admitted to a hospital with fever and jaundice. He had been diagnosed with bladder cancer several years earlier and received regular treatments with Bacille Calmette-Guerin (BCG). BCG is a live strain of bacteria similar to the tuberculosis bacteria. It is usually infused into the bladder using a urinary catheter. Diagnostic tests indicated that he had hepatitis but he had no known exposure to the hepatitis viruses. His physicians suspected that the BCG infusions had caused the hepatitis, and this was confirmed by a liver biopsy.

A 59-year-old man was admitted to a hospital with anorexia, fatigue, and weight loss. His symptoms had begun two years earlier. Chest X-rays and a CT scan showed a mass in between his lungs. Biopsy revealed that the mass was fatty tissue, leading his doctors to suspect sarcoidosis. However, microscopic examination of biopsy tissue from his small intestine revealed infection with the bacterium that causes Whipple's disease. The polymerase chain reaction was used to confirm the presence of the bacterium.

A 68-year-old woman was admitted to a hospital with the signs of heart failure and lethargy. She had a history of rheumatoid arthritis for which she took methotrexate. An abdominal ultrasound revealed fatty changes in her liver. An elevated iron count suggested that she probably had genetic hemochromatosis, which is characterized by excessive iron deposits in many organs. She also had an alpha1-antitrypsin deficiency. A liver biopsy showed evidence of liver cirrhosis and iron deposits. Methotrexate also could have contributed to her liver disease.

A 39-year-old woman was admitted to a hospital for evaluation of a mass in her stomach after a long history of abdominal pain. The mass had been found by a CT scan three months before. The mass was consistent with carcinoid tumor, which is a gastrointestinal tumor. A biopsy confirmed the diagnosis. This patient had pernicious anemia, which has often been linked to carcinoid tumor. The mechanism probably involves a cell proliferation induced by high levels of gastrin. Patients with pernicious anemia do not produce normal levels of stomach acid, which regulates the amount of gastrin secreted.

A 33-year-old man with a history of kidney disease and leukemia was admitted to a hospital for a bone marrow transplant. Twenty-one days after the transplant, he developed a widespread rash and evidence of ascites. Ascites is an accumulation of fluid in the abdomen that often occurs during liver failure. The ascites persisted and he subsequently developed respiratory failure as well as kidney failure. He died and an autopsy revealed that he had developed veno-occlusive liver disease, probably from the chemotherapy and radiation he received for his leukemia.

People with long-standing celiac disease who experience a relapse should have intestinal biopsies to detect T cell lymphoma. Celiac disease is characterized by intestinal malabsorption. A 79-year-old woman with celiac disease of 10 years' duration was hospitalized with lack of appetite, weight loss and diarrhea. Prednisone treatment resolved some of her symptoms but fiberoptic endoscopy revealed many large ulcers in her stomach. Biopsy samples of tissue around the ulcers were found to contain malignant tumor cells, which were identified as T cells. Two days later, exploratory laparoscopy revealed a large white mass in the stomach and small nodules in the small intestine. She eventually developed congestive heart failure and died. People with long-standing celiac disease are known to have a high risk of lymphoma.

A 32-year-old woman with a mass in her liver, occasional fever, weight loss, and pain beneath her ribs was found to have a liver cancer known as fibrolamellar hepatocellular carcinoma. Imaging tests showed that the woman had a mass in her left liver with numberous blood vessels and a region of dead cells or scarring. Upon surgery, the tumor was removed and tissue analysis indicated the diagnosis. The tumor was 12 centimeters (cm) by 10 cm by 6 cm and did not invade the surrounding liver tissue or adjacent stomach. Six months after the surgery the patient was well, her symptoms had resolved, and she had no evidence that the cancer had returned. Although hepatocellular carcinoma often results in death within a few months, prognosis is better for the fibrolamellar type, which is more common among young people.

A 35-year-old woman was admitted to a hospital because she was passing bloody stool. She had first been diagnosed with a bleeding stomach ulcer 21 months earlier. She had received various drugs to eliminate Helicobacter (H.) pylori infection, which doctors thought was causing the recurring ulcer. Fiberoptic endoscopy revealed fresh blood in her stomach and a large ulcer. Biopsy samples of stomach tissue did not contain H. pylori, but showed evidence of a B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) origin. This type of lymphoma is relatively benign. She was treated with radiation to the stomach, and endoscopy and biopsy three months later revealed a healed ulcer and so sign of the lymphoma.

Older adults with severe diarrhea should be evaluated for digestive and absorption problems, such as intolerance to grains. A 74-year-old woman with a history of chronic diarrhea, dehydration, abdominal pain and severe weight loss was eventually diagnosed with celiac sprue. This is an intolerance to specific cereal proteins in the diet such as gliadin in wheat. Telltale findings which led to the final diagnosis were small-bowel thickening with mesenteric lymphadenopathy. Celiac disease starts in childhood, but is not usually diagnosed until adulthood. An enteropathy-associated lymphoma as a complication of celiac disease was suspected in this patient because of her advanced age, but the anatomical diagnosis did not reveal lymphoma. The patient survived the symptoms of the disease, and was treated with a gluten-free diet. She experienced only a couple of episodes of diarrhea in 11 months of following the new diet.

A patient who had recently undergone chemotherapy for cancer of the tongue and later was admitted to the hospital because of bloody diarrhea and nausea was diagnosed with hemorrhagic colitis with transmural necrosis consistent with Escherichia (E.) coli infection. Hemorrhagic colitis with transmural necrosis refers to a bleeding, inflamed colon with degenerating and dead tissues. The patient died on her eighth day in the hospital of a stroke, following peritonitis leading to shock caused by bacterial infection of the bloodstream. The E. coli infection was not detected in the patient's stool specimens until after she died. One of the doctors reviewing this case thought it more likely that she had an infection of Clostridium (C.) difficile rather than E. coli, as C. difficile has been found to cause pseudomembranous colitis associated with chemotherapy. No test for C. difficile was done on stool specimens. A pathologist who reviewed the slides also said C. difficile infection was possible.

Intermittent abdominal pain, vomiting and weight loss may be evidence of a giant pseudodiverticulum of the sigmoid colon. Diverticulosis, which is believed to be the cause of pseudodiverticulae, is the presence of a pouchlike herniation through the muscular layer of the colon. The most common symptom is bleeding from the rectum. A 47-year-old woman complaining of these symptoms, but no bleeding from the rectum, had experienced abdominal pain and vomiting on and off for a number of years. Radiograph of the abdomen revealed a 7.5 centimeter air-containing, smooth-walled structure in the pelvis. Three months after the pseudodiverticulum was surgically removed the patient had suffered no further abdominal pain and had regained 6.8 of the 36 kilograms of weight she lost during her illness.

An 80-year-old woman was diagnosed with chronic radiation enteropathy. Radiation enteropathy is a radiation-induced intestinal disease characterized by adhesion of tissue, narrowing and constriction of the intestine, areas of thinning and loss of cells. She was hospitalized because of persistent bleeding from the stomach and intestines. A radionuclide scan indicated that the right side of the colon was the source of bleeding. Part of the right colon was removed, but bleeding continued. She had a history of chest pain, congestive heart failure, degenerative joint disease and hysterectomy followed by radiation therapy. Samples of her feces contained blood. Examination of biopsy samples showed evidence of changes caused by radiation throughout the intestines. Two segments of her small intestine were removed, but abdominal abnormalities developed two weeks later. Surgery was performed again, but she died from an infection of the abdominal lining.

Recurrent abdominal pain may be caused by acute pancreatitis related to Crohn's disease. Crohn's diseases is an inflammatory disorder, commonly involving the small intestine, characterized by scarring and thickening of the bowel wall. Acute pancreatitis is inflammation of the pancreas usually with sudden onset of abdominal pain, nausea and vomiting. An 11-year-old boy was hospitalized for recurrent abdominal pain not related to food intake or activity. Fecal specimens were negative for blood and parasites. Films of his intestines showed thickening and narrowing of the bowels. He was unsuccessfully treated over several months with ferrous sulfate, low-fat diets, low-protein diets, elemental diets and ranitidine, a histamine blocker used to treat gastrointestinal disorders. He was finally diagnosed with acute pancreatitis and Crohn's disease. A colonoscopic examination showed inflammation of the small intestine and colon. He was successfully treated with metronidazole and mesalamine.

A 76-year-old woman was diagnosed with Crohn's disease complicated by infectious gastroenteritis. The patient was admitted to the hospital with chronic diarrhea. She was treated successfully with antibiotics for suspected tropical sprue, or tropical diarrhea, which she developed eight months earlier during a trip to India. After approximately four months, the diarrhea recurred. Her condition did not improve, despite treatment with pancreatic enzymes and a lactose-free diet. A computed tomographic (CT) scan of the abdomen and pelvis showed several dilated loops in the middle portion of the small intestine. Other loops in the small intestine showed moderate thickening of the intestinal wall. A radiological study of the upper gastrointestinal tract revealed segmental dilation in the small intestine with narrowing in some areas. The patient was diagnosed with Crohn's disease after an exploratory laparotomy.

A 24-year-old man was diagnosed with eosinophilic gastritis. Eosinophilic gastritis is inflammation of the stomach involving the infiltration of eosinophils, a type of white blood cell. The patient was admitted to the hospital with nausea and stomach pain after undergoing treatment for a hernia. He had been treated for asthma with corticosteroid drugs since childhood and ha experienced occasional difficulty in swallowing and nausea, vomiting and abdominal pain after meals for a number of years. Examination of the patient's gastrointestinal tract did not reveal any abnormalities. A tissue biopsy from his gastrointestinal tract, however, showed that he had allergic eosinophilic gastritis that may have been caused by food allergies. He was treated with prednisone for two weeks, and maintained on oral cromolyn sodium. His symptoms subsided and he gained weight.