This document presents the case of a 50-year-old male patient admitted with a one-month history of abdominal mass. The patient reports loss of appetite, weight loss, abdominal fullness, and fever over the past several months. On examination, the patient appears ill and anemic with ascites present and an irregular, firm, fixed abdominal mass found. Differential diagnoses include carcinoma of the stomach or abdominal tuberculosis. Further tests planned include endoscopy, CT scan, and blood tests.

1. Patients case
presentation
Dr. Mohammed Sanwar Hussain
Intern Doctor Medicine Unit II
Sylhet MAG Osmani Medical college and Hospital

2. • A 50 years male admitted with mass in the
abdomen for 1 month

3. Particulars of the patient
• Name : Mr. Bimol Sutrodhar
• Age : 50 years(Male)
• Father’s Name : Late Bihari Sutrodhar
• Occupation : polli chkitshak
• Religion : Hindu
• Address : Hobibpur, shallah, Sunamganj
• Date of Admission : 06.05.19 at 3.20pm
• Date of examination : 10.05.19 at 3.00pm

4. Chief Complaints:
• Mass in Abdomen for 1 months
• Anorexia, weight loss & Abdominal fullness for the same duration

5. History of present illness
• According to the statement of the patient, he was reasonably well 8 months
back. Since then he has been suffering raised temperature on abdomen
measuring around 100 degree Farenheit. Fever use to come at afternoon and
go at night. Associated with shivering. It occasionally reduced after taking
Azithromycin. There is no history of induced or projectile vomitting. The
patient also complains of weakness, marked loss of appetite and weight loss
for the last 3 months. There is no history of melena or cough. His bowel
habits altered

6. History of past illness
• He has history of knee joint swelling and walking difficulty since 2004
• Haemorrhoids Grade I

7. Family History
• 7 brothers & 3 sisters
• One brother Had abdominal TB and died 2 years after following disease
almost 15 years back.

8. Personal history
• He is a polli chikitshak and used to smoke.

9. Socioeconomic history
• He is from lower socioeconomic condition and lives in rural area

10. Drug history
• Azithromycin
• Algin
• Ketorolac
• Monas

11. General examination
• Ill looking
• Mildly anemic
• No jaundice,cyanosis,clubbing,
• No koilonychias,leukonychia
• Ascites present
• No lymphadenopathy
• Pulse:66 bpm
• BP: 110/70 mmHg
• Temperature:101 degree
• Respiration: 18 breaths/min

12. Systemic Examination
Gastrointestinal system:
Lips are tar stained, teeth is black stained. Upper margin of incisor teeth lost.
Tongue is dry and whitish(oral thrush)

13. Abdomen
• Inspection: visible mass in above umbilical region. Abdomen slightly distended
• Auscultation:Boborygmi Audible
• Percussion: Tympanic,dullness over mass region
• Palpation:There is ill defined mass in the umbilical region, 1 x 1 cm, margin
irregular,tender,firm in consistency,surface slightly irregular,fixed from side to side
• Liver:not palpable
• Spleen:not palpable
• Kidneys:not ballotable

14. • Examination of other systems reveals no other Abnormalities

15. Differential Diagnosis
• Carcinoma of stomach
• Abdominal TB

16. Investigations
• CBC with ESR
• RBS
• Serum electrolyte
• Serum creatinine
• USG of Whole Abdomen

20. Plan
• Endoscopy of upper GIT
• CT scan of abdomen