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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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Presentation Transcript
initial presentation
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.
slide2
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
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 d1
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
Physical examination
  • BMI: 15
  • BP: 132/86 mmHg
  • HR: 84 beats/minute
  • RR: 22 breaths/minute
  • Temperature: 37 °C
more examination
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
slide7
DDx
  • What test should we order?
  • What organs should we check for?
blood test
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
slide9

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
Guaiac Stool Test
  • Results indicate a positive guaiac stool test
  • What does this indicate?
more examination1
More examination
  • Colonoscopy
  • Exploratory surgery
  • CT scan
  • MRI
  • PET Scan
  • Xray
results
Results

Results of colonoscopy and CT scan revealed:

  • Proximal ascending colon, mass, biopsy: poorly differentiated invasive adenocarcinoma with ulceration
  • Transverse colon, biopsy: tubular adenoma
treatment
Treatment
  • Surgery?
  • Iron supplement
  • Erythropoietic therapy
  • chemotherapy
ad