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Long Case 5years

The document presents a case study of a 60-year-old male patient with epigastric pain, vomiting, weight loss, and recent heartburn, suggesting gastric outlet obstruction (GOO) likely due to distal gastric cancer. It outlines potential laboratory abnormalities, necessary investigations, and discusses causes of weight loss and jaundice. The document also includes a scoring system for evaluating responses to clinical questions related to the case.

Uploaded by

Dr-Mohammad Ali-Fayiz Al Tamimi
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37 views2 pages

Long Case 5years

The document presents a case study of a 60-year-old male patient with epigastric pain, vomiting, weight loss, and recent heartburn, suggesting gastric outlet obstruction (GOO) likely due to distal gastric cancer. It outlines potential laboratory abnormalities, necessary investigations, and discusses causes of weight loss and jaundice. The document also includes a scoring system for evaluating responses to clinical questions related to the case.

Uploaded by

Dr-Mohammad Ali-Fayiz Al Tamimi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CANDIDATE SHEET

5th YEAR LONG CASE MANAGEMENT

A 60 Years old male patient presented with a complain of epigastric pain for one
month. This pain is associated with fullness in epigastric region, repeated
vomiting 2hours after meal as gastric content without bile stain in the last 10 days
with bad taste and odor. No blood in the vomitus. He has loss of appetite and lost
10 kg in the last 3months. The patient also has heart burn started 1 weak after the
onset of symptoms.

1. What is your primary diagnosis?

2. What laboratory abnormalities you suspect? And why?

3. What other important investigations?

4. What is the most likely cause of this recent heart burn? Explain it well

5. What are the possible causes of weight loss in this case?

6. If he developed jaundice, what are the most likely causes of it?


GASTRIC OUTLET OBSTRUCTION 5years Mark Tick
1 Gastric outlet obstruction (GOO) 2
If he gives the correct answer, ask him what is the most likely 1.5
cause in this patient?
His answer should be distal gastric cancer

If he answered, ask him what benign condition might lead to 1


GOO
His answer: chronic DU
2 Hyponatremia, Hypochloremia, metabolic acidosis, elevated 4.5
urea and creatinine: due to loss of gastric juice (2 points)
Ask how to correct it, answer: give normal saline or half saline
IV (1 point)
Prolonged INR because vitamin K will not reach the bowel, and
hypoprotenemia and hypoalbuminemia (1 point)
Elevated CEA: a tumor marker (0.5)
3 Chest, abdomen and pelvis CT scan with contrast (1 point) 3
Upper GI endoscopy with biopsy of the lesion if present (1
point)
If asked it ask him what difficulty is present in doing it and how
to solve it?
Answer: full stomach due to obstruction so NG tube inserted
the day before endoscopy and gastric emptying and washing
done (1 point)
4 GERD due to high intra-gastric pressure due to distal obstruction 1
5 Malnutrition due to gastric obstruction and effect of cancer 1

6 Either biliary obstruction by large distal gastric tumor invasion 1


or massive liver metastasis
Total mark 15

Agreed mark
Names and signatures of the examiners

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