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Initial Presentation. A 52-year-old Caucasian female was admitted to the hospital 2 days ago with complaints of unexplained weakness and fatigue. She also reported irregular menstrual periods and weight loss of 10 lbs over the past 6 months. Hx. Medical history:

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Initial Presentation

  • A 52-year-old Caucasian female was admitted to the hospital 2 days ago with complaints of unexplained weakness and fatigue. She also reported irregular menstrual periods and weight loss of 10 lbs over the past 6 months.


Hx

Medical history:

  • Patient reported chronic constipation and hemorrhoids, mild dyspnea on exertion, and chronic arthritis in her knees and hands.

  • Normal mammogram 8 months ago; has had no screening colonoscopy or sigmoidoscopy.

  • Currently taking diuretics, furosemide, ibuprofen, and oral contraceptives (10 years).


Hx Cont’d

Family History:

  • Mother (83 year-old) has type 2 diabetes since the age of 35.

  • Father died at age 60 due to acute myocardial infarction.

  • Brother is alive at age 61 with hypertension.


Hx Cont’d

Social history:

  • Owner and manager of interior design firm

  • Divorced with 2 grown children

  • Lives alone

  • Non-smoker; rarely drinks alcohol

  • Avid tennis player


Physical examination

  • BMI: 15

  • BP: 132/86 mmHg

  • HR: 84 beats/minute

  • RR: 22 breaths/minute

  • Temperature: 37 °C


More Examination

  • Karnofskyperformance status was 90%

  • No palpable adenopathy

  • Lungs were clear to ausculation

  • Normal cardiac examination

  • No hepatosplenomegaly

  • Normal rectal examination

  • Abdomen was soft w/o distention or tenderness

  • Normal bowel sounds


DDx

  • What test should we order?

  • What organs should we check for?


Blood test

  • WBC: 5200 cells/mm3

  • Hgb: 7.5 g/dL

  • Hematocrit: 26%

  • Reticulocyte: 1.5%

  • Creatinine: 1.1 mg/dL

  • Total bilirubin 0.9 µmol/dL

  • Blood urea nitrogen 15 mg/dL

  • Glucose 124 mg/dL

  • Sodium 134 mEq/L

  • Potassium 4 mEq/L

  • Magnesium 1.8 mEq/L

  • Total calcium 9.2 mg/dL

  • Serum ferritin: 8 ng/mL


By now, what can we conclude about the diagnosis of the patient?

What other tests can indicate the underlying cause of this problem?


Guaiac Stool Test

  • Results indicate a positive guaiac stool test

  • What does this indicate?


More examination

  • Colonoscopy

  • Exploratory surgery

  • CT scan

  • MRI

  • PET Scan

  • Xray


Results

Results of colonoscopy and CT scan revealed:

  • Proximal ascending colon, mass, biopsy: poorly differentiated invasive adenocarcinoma with ulceration

  • Transverse colon, biopsy: tubular adenoma


Diagnosis

???


Treatment

  • Surgery?

  • Iron supplement

  • Erythropoietic therapy

  • chemotherapy


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