case Summary

Maybe this time i would write case summary in my entry here. haha. Just for fun. realizing that i have clerked so many patient, why don't i share some of them with the people. By the way, information here is so confidential so all the identification information will be changed or removed.


Case 1 A 69 years old male presented to the hospital with the chief complain of localized abdominal pain and distension for 4 days. The pain is localized at the epigastric region, stabbing in nature, non-radiating and aggravated by taking food. It is associated with nausea and vomiting. the vomitus contain partially digested food particles. The distension at the epigastric region was noticed by the patient himself after the epigastric pain occured. On further questioning, patient also loss his appetite and weight since 4 months ago and had an altered bowel habit since 2 months ago. Patient was having difficulty in passing hard and small amount of stool. There were no blood noticed in the stool. On examination, patient is comfortable however looks cachexic. Pallor was noted on conjuctiva however there is no jaundiced noted on sclera. There is mild pedal oedema noted. Abdominal examination reveals a hard, tender and fixed mass measuring around 8cm X 10 cm oval shape mass in the epigastric region. Liver and spleen are not enlarged and kidneys are not ballotable. Mild shifting dullness can be elicited on percussion. The mass is also dull on percussion. Bowel sound is present and no bruit heard on auscultation of abdomen.

Per rectal examination done and no mass is noted.

Other systems reveal no abnormality.



Diagnosis: You think about it! hahaha.

Comments

  1. Interesting...
    Most interesting...

    I'm surprised that given the amount of readers no one decided to comment on this... :(

    One thing that I must say before I give my opinion is that I am not a doctor, I am
    just a nurse..
    So please forgive me if I am wrong or if my points seem irrelevant.. :/
    I hope you won't mind..

    Okay, here I go..

    On first impression I would suggest it as a typical case of gastritis (epigastric pain aggravated after food, stabbing in nature, vomiting)

    However upon further reading this might not be the case..

    Am I to understand that the patient had weight loss x 4/12 and change of bowel habits x 2/12, and only complained of epigastric pain and distention only four days prior?

    This in itself leans heavily on malignancy, and in this case stomach cancer.. :/

    - Hard and small stool is suggestive of dehydration or intestinal obstruction?, however, there is absence of noticeable blood in stool (a stool occult blood test could be done to further investigate the and confirm the matter :)
    PR examination is also normal, so at least sigmoid CA is definitely ruled out..

    - Conjunctival pallor is suggestive of anaemia, which coincides with the weight loss

    - mild pedal edema in this case ,
    Assuming that it is bilateral and considering that you mention that the other systems are normal..
    I can hopefully rule out cardiac congestion, renal / hepatic failure, and vascular thrombosis and localised cellulitis as the cause..
    This is perhaps caused by reduced albumin production due to malnutrition? Or perhaps.. even idiopathic in this case ?

    - Cachexia further suggests towards malignancy in this case

    - absence of jaundice and liver is not enlarged suggests that the liver is normal

    - normal spleen rules out liver cirrhosis, hemolytic anemia and leukemia..

    - kidneys that are not ballotable suggests normal kidneys

    - there is a reasonably large mass in the epigastric region

    So..

    My diagnosis is gastric cancer.

    I suggest doing an OGDS with biopsy of the mass..

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  4. Chucky Charlie12:56 pm
    I posted this when I was an intern / house officer. I didnt remember about it anymore. But if I read it now, I would also said its a gastric cancer.

    ReplyDelete

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