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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. Hx. Medical history:

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Initial Presentation

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  1. 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.

  2. 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).

  3. 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.

  4. 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

  5. Physical examination • BMI: 15 • BP: 132/86 mmHg • HR: 84 beats/minute • RR: 22 breaths/minute • Temperature: 37 °C

  6. 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

  7. DDx • What test should we order? • What organs should we check for?

  8. 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

  9. By now, what can we conclude about the diagnosis of the patient? What other tests can indicate the underlying cause of this problem?

  10. Guaiac Stool Test • Results indicate a positive guaiac stool test • What does this indicate?

  11. More examination • Colonoscopy • Exploratory surgery • CT scan • MRI • PET Scan • Xray

  12. Results Results of colonoscopy and CT scan revealed: • Proximal ascending colon, mass, biopsy: poorly differentiated invasive adenocarcinoma with ulceration • Transverse colon, biopsy: tubular adenoma

  13. Diagnosis ???

  14. Treatment • Surgery? • Iron supplement • Erythropoietic therapy • chemotherapy

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