Clinical case: what´s your election?
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Transcript of Clinical case: what´s your election?
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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.
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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
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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.
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Gastric and small bowel wall thickening.Mesenteric adenopathy. Ascites.
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SOME DAYS LATER: small bowel thickening. Pleural effusion.
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Ileus. Small bowel thick and dilatated. Ascites.
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Digestive functional studies
• Fecal culture: negative; no parasites.
• No steathorrea.
• D-xylosa test: normal
• Clostridium difficile toxin: negative.
• Occult fecal blood: positive.
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Endoscopy studies
• Gastric biopsy: inflamatory changes, no atrophy.
• Colonoscoy: normal. No bacterias or parasites.
• Terminal ileum: normal
• Red Congo: negative