Incidental Gastric Polyps

35 yr old male complaining of Abdominal fullness , passing of loose stool ,. investigation attached . guide the management.

GASTROINTESTINAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: Gastrointestinal complications are common in SLE. ORAL CAVITY : Mucous membrane involvement occurs in 12-45 %of patients with SLE.Oral or nasopharyngeal ulceration are usually painless and is one of the eleven diagnostic criteria of SLE.The ulcers are discoid or ulcerative DISCOID lesions are painful,characterized by erythema,atrophy and depigmentation and usually occurs on lips. ULCERS are punched out erosions with surrounding erythema,irregularly shaped raised white plaques tend to occur on hard or soft palate and buccal mucosa.These are usually painless. TREATMENT of oral lesions: *Topical glucocorticoids. *Tacrolimus ointment. *Intralesional corticosteroids. *Systemic antimalarial drugs. OESOPHAGUS : DYSPHAGIA,DYSMOTILITY,VASCULITIS, ISCHEMIA,ULCERATION,PERFORATION. DYSPHAGIA:Dysphagia occurs due to SLE or to complications associated with therapy such as pill oesophagitis and oral candidiasis DYSMOTILITY :Hypotensive LES(lower esophageal sphincter) and aperistalysis are documented by manometry. VASCULITIS-ISCHEMIA-ULCERATION- PERFORATION :Ischemia from vasculitis can lead to esophageal ulceration and perforation. TREATMENT : *Hypomotility is treated with metaclopramide. *GERD symptoms are treated with routine GERD precautions and proton pump inhibitors. *Immunomodulatory agents are used for treating SLE,but they can cause opportunistic oesophagitis from candidiasis,cytomegalovirus and herpes simplex virus. STOMACH &DUODENUM : DYSPEPSIA,PEPTIC ULCER DISEASE AND GASTRIC ANTRAL VASCULAR ECTASIA (GAVE) DYSPEPSIA is due to treatment with NSAID's or corticosteroids. PEPTIC ULCER DISEASE is also due to NSAID's and corticosteroids.Therefore prophylactic therapy for peptic ulcer is beneficial in SLE patients with dyspepsia,history of peptic ulcer disease,and on therapy with NSAID's and corticosteroids. GAVE :GAVE is an erosive type of atrophic gastritis characterized by marked veno-capillary ectasia.This causes chronic gastro- intestinal bleeding or irondeficiencyanemia. Dilated small blood vessels cause streaky long red areas that resemble the markings on watermelon when viewed endoscopically SO CALLED AS WATERMELON STOMACH. SMALL &LARGE BOWEL : ABDOMINAL PAIN,GASTROINTESTINAL BLEEDING,DYSMOTILITY,DIARRHEA,PROTEIN LOOSING ENTEROPATHY ,PNEUMATOSIS CYSTOIDES INTESTINALIS ,RECTAL ULCERS, STEATORRHOEA,PANCREATITIS, ACALCULUS CHOLECYSTITIS : ABDOMINAL PAIN : can be caused by mesenteric vasculitis and infarction,acalculous cholecystitis,peptic ulcer disease and pancreatitis. IINTESTINAL VASCULITIS. causes transmural inflammation with fibrinoid necrosis.It is most commonly found in terminal ileum and cecum where the blood supply is from superior mesenteric artery.Endoscopically,the bowel appears thickened and friable with ulceration and submucosal hemorrhages. COLON focal /diffuse ulcers,ischemic colitis or colonic diverticula. PROTEIN LOOSING ENTEROPATHY (PLE) This is characterized by significant hypo- albuminenia and diarrhea without proteinuria These are a result of villous atrophy with inflammatory. infiltrates and submucosal edema.Disease activity is measured by monitoring fecal excretion of radiolabelled albumin. PNEUMATOSIS CYSTOIDES INTESTINALIS PCI is gas filled cysts in the submucosa or subserosa of bowel wall.This radiological sign is suggestive of necrotising enterocolitis STEATORRHEA :occurs secondary to villus blunting and immune complex deposition.

Old age female parient with andominal pain and black coloured stool for 3 days .. OGD report is as follows please advise for further management

Patient presented with repeated burping and chest discomfort *Chief Complaints* Severe dyspepsia *Investigations* USG whole abdomen-- normal Barium swallow-- normal Barium meal study-- normal UGI endoscopy-- normal

A 24 yr old female presenting with fatigue and breathlessness and rash around neck. She has a history of raised IgE levels. CBC was done giving pictures of megaloblastic anaemia. CRP is raised. What can be possible diagnosis?? Reports are attached.