32 years old lady presented with repeated attacks of hematemsis and Significant weight loss for further investigation

1. Thursday's Conference
Ahmed Adel Fouad - MBBCh
PGY-2 Resident of Internal Medicine
March, 2017

2. Patient Information
• 32 years old Lady
• Known Asthmatic for 7 years.
• No known Drug Allergy.
• Single daughter 10 years old.
• Appendectomy and Salpingoplasty.
• Passive Smoker.

3. Chief Complaint
• Bloody Vomiting.
• Also currently complains of :
Significant weight Loss.

4. History Of Present Illness
• One year ago the patient had single attack of hematemesis one
month later progressed with multiple attacks of hematemesis
associated with epigastric pain.
• These attacks weren't precipitated by certain stimuli , not
associated with change in bowel habit, melena or hematochazia .
• The epigastric pain wasn't related to meal.
• The patient isn't known Analagesic abuser.

5. History Of Present Illness – Cont'd
• OTC medications were given and didn't relieve the symptoms
• April 2016 – an UGI endoscopy:
Superficial duodenal > gastric erosions .
• Biopsy : H.Pylori associated gastritis and duodenitis.
• Triple Therapy was given : epigastric pain improved but recur later

6. History Of Present Illness – Cont'd
• One month ago, the patient noticed :
Significant weight loss " around 23 Kgs " .
Night Sweating.
Night Fever.
Productive Cough " Greenish Sputum " .

7. Examination
• Vital Data : Vitally Stable , recently has increased Temperature "38"
• General : Cachexia – Hair Loss – Oral Moniliasis –
NO Lymphadenopathy .
• Chest : Rhonchi – Whezzes.
• Heart : Normal Heart Sounds – No murmurs.
• Abdomen : Lax – No Organomegaly –
Moderate Epigastric tenderness.
• Limbs : No L.L Edema – No skin Pigmentation.

8. Labs
22/2 27/2 2/3 22/2 27/2 2/3
BUN 11 5 5 TLC 7.7 6.8 4.4
Creatinine 0.9 1.1 0.8 PNL 4.31 3.7 1.15
Na 140 139 138 LYMPH. 2.43 2.32 2.26
K 3.2 3.3 3.2 MONO 0.81 0.47 0.77
T.Bili 0.5 0.4 0.3 HB 11.9 12.2 11
D.Bili 0.3 0.1 0.1 MCV 76.3 76.4 76.5
AST 25 24 19 PLT 226 352 292
ALT 15 14 11 Retics 0.8
T. Proteins 6.7 5.7 PTT 20.2 32.6 30.2
Albumin 3.8 3.7 3.4 INR 0.9 1.12 0.94

9. Labs
• Amylase: 39
• LDH: 162
• CRP: <6
• HBVsAg : -ve
• HCV Ab: -ve
• HIV Ab: -ve
• CA125 :154.6
• CA19.9: 26.39
• CEA: 1.6

10. Procedures
• UGI Endoscopy :
1. Esophageal Moniliasis.
2. Multiple prepyloric Ulcers.
3. Bulb Duodenitis.
• Colonoscopy:
Normal Colono up to ascending colon

11. Other
• Tuberculin Skin Test : +ve
• TB- Gold Quantiferon : Pending

12. Questions ?

13. Thank You
Ahmed Adel Fouad - MBBCh
PGY-2 Resident of Internal Medicine
March, 2017