Clinical case: First part

1. Clinical case
• A 33-year-old woman started with hyporexia, edema and
mild abdominal pain in the last 3 months. No vomiting.
No fever. No constipation, occasional diarrea.
• No previous disease. Family history: father died from
lung cancer.
• Physical examination: Dehydratation. No dyspnea.
Normal pulmonar and cardiac sounds. Abdomen:
distension, with intestinal movements. Legs: bilateral
edema; no DVT signs.

2. Laboratory
• Hemoglobin 6,8 g/dL.VCM 74.HCM 24.
• Normal coagulation.
• Protein 3,5 g/dL. Albumina: 2 g/dL.Ig G 273 mg/dL.IgM
43 mg/dL.Ig A 74 mg/dL.Colesterol 125 mg/dL.
• LDH: 602 UI/L.
• Fe: 7 mg/dL. Transferrine saturation index: 11%.
Ferritine 65 ng/mL.
• Urianalysis: normal. Protein: negative.
• Coombs direct: positive

3. Summary
• A patient without previous diasease, with a
general deterioration, asthenia, weight loss in
the last three months with abdominal distension,
mild diarrea and edema in both legs, without
proteinuria and mild diarrea.
• No fever
• CONCLUSION: Cachexia/Diarrea/Small bowell
wall thick.

4. Gastric and small bowel wall
thickening.
Mesenteric adenopathy. Ascites.

5. SOME DAYS LATER: small bowel
thickening. Pleural effusion.

6. Ileus. Small bowel thick and dilatated. Ascites.

7. Digestive functional studies
• Fecal culture: negative; no parasites.
• No steathorrea.
• D-xylosa test: normal
• Clostridium difficile toxin: negative.
• Occult fecal blood: positive.

8. Endoscopy studies
• Gastric biopsy: inflamatory changes, no
atrophy.
• Colonoscoy: normal. No bacterias or
parasites.
• Terminal ileum: normal
• Red Congo: negative