PBL CASE

• Patient - 35-year-old Danish man came to GP with abdominal pain of

low intensity, without clear localization, nausea, stool disorders
(constipation followed by diarrhea)
• By symptoms was diagnosed IBS and prescribed :
• Antispasmodics: Buscopan,
• dicytel Anxiolytics: Atharx, Amitriptyline.
• After 6 month the pain syndrome became more severe ,
• the pain is constant,
• most often localized in the right iliac region .
• the patient notes severe general weakness, malaise, temperature
rises to subfebrile, and weight decreases.
• Episodes of increased dyspeptic symptoms occur periodically.
• A 35 year old man moved to China 3 years ago.
• works as a teacher at school
• married with 2 children
• neither in the family nor in blood relatives there are diseases with
such symptoms.
• grew up in a two-parent family in Denmark.
• parents had a farm, so the patient loves milk and can hardly tolerate
the peculiarities of Japanese cuisine.
• CBC- determine :
• leukocytosis in the neutrophilic phase,
• eosinophilia,
• lymphopenia, and accelerated ESR.
• Dysproteinemia is detected.
• X-ray examination.
• The detection of calcified lymph nodes on a plain radiograph of the
abdominal organs indicates specific mesadenitis.
• a tuberous infiltrate is detected; the affected part of the intestine has
uneven contours, is deformed, the folds are thickened, smoothed;
ulcerations and narrowing of the ileum are visualized.
• Endoscopic examination of the intestine. When performing a
colonoscopy, various changes are revealed: ulcers of irregular shape,
rigidity of the walls, narrowing of the intestinal lumen
• The patient is prescribed to do Mantoux test