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27 year old female presented with:
C/O: Upper abdominal Pain(on/off) x 6
month Occasionally nausea,vomiting Shortness of Breath on exertion+ Menorrhagia+
ON EXAMINATION
General Condition: Malnourished+, Body Mass Index(BMI)=14.06 Jaundice:Nil Anemic :Mild LN:Nil Cyanosis:Nil Clubbing:Nil Oedema:Nil Dehydration:Nil VITALS: P:80/min BP:80/40mmHg R/R:20/min T:afebrile
Chest: B/L clear air entry CVS:S1.S2.M0
P/A:Soft tenderness around Right Hypochondriac Region+ Hepatomegaly+
MEDICAL h/o: no h/o DM,HTN,PTB,Hepatitis
SURGICAL h/o:Appendicectomy done last
year, 2 C.S Performed
ALLERGIC h/o:non significant
PERSONAL h/o:Non Significant
COMPLETE BLOOD COUNT: WBC:14.28X10*9/L(N=72.9%),L(17.1%), RBC:3.34X10*12/L,HB:76g/L,HCT:25.6%,MCV:76.6fl,RET%:2.5% PLT:631X10*9/L
Tumor Marker:CA 125,CA 19-9,AFP,CEA =all are Normal
Renal Function Test: Within Normal Limits
Biochemistry: Gluc=5.87mmol/L, Amylase:370U/L,Ca:2.12mmol/L Albumin:29.2g/L,ESR:100mm/hr,CRP:125.89mg/L
Liver Function Test: Within Normal Limits
URINE R/E,STOOL R/E:Normal Findings
Etiology Of Weight Loss
Addison’s Disease Cancer HIV/AIDS Tuberculosis Celiac Disease Crohn's Disease DM Hyperthyroidism COPD Heart Failure Peptic Ulcer Parkinson’s Disease
DISCUSSION
BMI is only 14.06 suggests passing is severely malnourished,albumin is also low so is transfusion of albumin and Nutrients rich diet is must for management?
Addison’s Disease is the leading cause of wieght loss, did we evaluated it?
Low Hb,elevated Platelets,raised ESR,CRP and WBC with abdominal pain is highly suggestive of
Ulcerative Colitis & Crohn’s Disease?
What may be the likely cause of Iron Deficiency Anemia in this patient?
Further Investigations Probably Needed
Endoscopy,Colonoscopy to rule out Ulcerative Colitis ,Crohn’s Disease?
Contrast Enhanced CT for more proper visualization?
Laparascopic evaluation of abdomen
REFERENCE
www.mayoclinic.orgHarrison’s Principle of Internal Medicinewikipedia
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