نوع مقاله : مقاله پژوهشی
نویسندگان
1 استاد بیماریهای داخلی، دانشگاه علوم پزشکی مشهد، مشهد، ایران
2 استادیار بیماریهای گوارش وکبد بالغین، دانشگاه علوم پزشکی مشهد، مشهد، ایران
3 استادیار گروه روانپزشکی، مرکز تحقیقات روانپزشکی و علوم رفتاری، دانشگاه علوم پزشکی مشهد، مشهد، ایران
4 فلوشیب بیماریهای گوارش وکبد بالغین، دانشگاه علوم پزشکی مشهد، مشهد، ایران
چکیده
عنوان مقاله [English]
نویسندگان [English]
A 46 years old gentleman was admitted to hospital following a 10 months history of sever diarrhea. On examination, the patient appeared as mildly dehydrated though his vital sings were within normal limits.important result tests were:
Bun=55 mg/dl Na=149 mEq/dl WBC=11.6*103/ml Hemoglobin=16.2 g/d
Cr=3 mg/dl K=3.9 mEq/dl HCT=49.7% Plt=324*103 Tbo/ul Neutr=74%
After ten days administration of IV fluid, BUN and createnine gradually became normal (Cr=1.1 mg/dl, BUN=14mg/dl).
There was no macroscopic or microscopic gastrointestinal pathology in upper and lower endoscopy. We took biopsies even from ileum terminal.
We suspected endocrine tumors and pancreatic disorders, so we requested abdominal and pelvic CT scan (IV and oral contrast) and hormonal tests such as serum cortisole, metanephrin, normetanephrine, which were all normal. We therefore did an octrotide scan which was again normal.
Because almost all organic etiologies of chronic diarrhea were excluded, we focused on neurological and psychological causes of chronic diarrhea. Therefore we consulted with neurologist & psychiatrist and they recommended brain CT scan and EEG which were normal. After complete interview, the psychiatrist diagnosed PTSD and depressive disorder NOS and prescribed imipramin 25mg/day. After 10 days the chronic diarrhea improved.
As we excluded all the organic causes, we concluded likely the patient had IBS with PTSD and depressive disorder NOS.
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