Sunday, 28 June 2009

Case 3 - Spot Diagnosis

A 71 year-old man presented to casualty with the non-specific symptoms of weight loss (from about 80 kg to 70 kg over four months), anorexia, constipation and fatigue. These symptoms had been gradually increasing in intensity over several months.

Question 1: What is anorexia?

Students often confuse the symptom of anorexia with the medical condition "anorexia nervosa". Anorexia is simply an inappropriately depressed appetite. (This definition distinguishes the condition from that "full" feeling or satiety that you have after wolfing down a massive hamburger.)

Question 2: What is particularly worrying about this man's symptom constellation?

An elderly man with a chronic change in bowel habit should reflexly prompt you to consider the possibility of colon cancer, even if another diagnosis is more likely. In this man's case, there are additional "red flags" that make this diagnosis a distinct possibility: weight loss and anorexia.

On examination the man was noted to be wasted, and had conjunctival pallor. He had no significant lymphadenopathy or organomegally, and his cardiovascular, respiratory and neurological examinations were normal apart from a tachycardia of 102 bpm. His abdomen was slightly distended, but there was no evidence of peritonism and bowel sounds were normal. A rectal exam was normal.

In addition to bloods, both chest and abdominal X-rays were ordered. Below is (something very similar to) his chest X-ray:

Question 3: What does the chest X-ray show?

We'll answer that tomorrow.

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