C1
Female 68 year olds with known case of DM, HTN - currently taking aspirin, diuretics HTN/DM medications, [currently having gallbladder stone?] - no known allergins hx of past fall truama on left shoulder
Presented with 4m hx of progressive abdominal pain, dysuria, chronic constipation with sharp/burning pain on left flank radiating to the back, increased by movement.
- no dizziness
- no vomiting
- no chestpain
- no joint pain
- no melena
- no past surgeries; “cesarean;hernia, splenectomy, CABG”
- no anemia?
O/E; on examination
- Patient is concious and orientated - GCS 15/15
- tenderness on LT Flank
- …
Initial Assessment
- Pyelonephritis
- Mass
- lymphoma
- encephalitis
- Sarcoidosis; no resp manifestation or clubbing
- pancreatitis; radiating to back
- renal stone
- cholecystitis stone; usually pain on right side, radiating to the shoulder
- Uterus mass; radiating to flank
- Renal Stenosis
- IBS
- IBD
- Celiac; no malabsorption
Initial Treatment
- Analgesics
- Diuretics
- ?
Investigation & Findings
- Check Vital signs; Make patient stable
- basic investigation - cbc
- X-ray; bulk mediastinum
- CT: Multiple Central LN >9cm compressing Aorta, adenopathy - thick cloudy omentum - enlarged pelvic LN - no consolidation
- Colonscopy
- Interventional Radiology
- Biopsy
Differential Diagnosis:
- Abdominal TB
- Lymphoma
- Systemic disease
- Malignancy
- Sarcoidosis; no resp manifestation or clubbing
Plan
- LN Biopsy
C2
31 yo male turkey barber medically free, family hx of DM HTN, currently taking no drugs had 20D hx of slowly progressive hematemesis, exarcebated 5D ago with musckolucoskeletal pain when prompted to hospital.
Associated w/ cough + Night sweat, easy bruising since 2 months, cant eat or drink without vomiting at least twice per day lost 10 Kg in 20 D
Previously he donated liver to his father and is social smoking 2 pc 15 yrs
O/E
- Patient is alert and orientated
- Connected to IV line
- small multiple bruises scabs around body, elbow, wrist, feet, mouth
- cachexiac / Pale
- Liver surgical scar
Differential
- Peptic Ulcer,
- Peptic esophageal varices
- RT HRT Failure
- Leukemia
- Gastric Cancer
- Lung Cancer
- Liver cancer
Investigations
Bone Marrow biopsy showing Leukemia AML