Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Carcinoma Stomach Clinical Examination Discussion and Treatment
Sex: Male
Age: 62 years
Occupation: watchman
Socio economic status: lower middle
CHIEF COMPLAINTS
Loss of weight and loss of appetite for 5
months
Vomiting for 4 months
HISTORY OF PRESENTING ILLNESS
The patient was apparently normal 5
months back after which he developed loss
of weight and appetite- 5 months (6kgs)
H/o vomiting for past 4 months, insidious
onset, 1-3 episodes/day.
Contains food particles, not bile
stained,after 1-1.5hrs of consuming food,
not projectile, not relieved by medications.
H/o passage of black stools, tarry, sticky,
foul smelling stools for 1 month, 1-2
episodes/day
H/o nausea
No H/o hematemesis
H/o ball rolling movements present
H/o early satiety
No H/o difficulty in swallowing
No H/o abdominal pain/distension/belching
No H/o heartburn
No H/o abdominal mass
No H/o indigestion and epigastric discomfort
No H/o constipation and obstipation
No H/o fever
No H/o suggestive of chronic gastritis
? No H/o bone pain, breathlessness,
chest pain, hemoptysis
? No H/o swelling elsewhere in the body
PAST HISTORY
No H/o similar complaints in past
No H/o previous hospitalization/ surgery
No H/o DM,TB, HT, asthma, epilepsy,
typhoid, jaundice.
No H/o chronic drug intake
No H/o radiation exposure
PERSONAL HISTORY
Consumes non vegetarian diet
Normal bowel and bladder habits
No addictive habits
No H/o excessive consumption of coffee
No H/o consumption of high salt and high
calorie food
No H/o excessive consumption of spicy
foods
No H/o excessive consumption of
preserved foods
No H/o drug/food allergy
FAMILY HISTORY
No relevant family history.
GENERAL EXAMINATION
Patient is conscious, oriented,
moderately built and nourished,hydrated.
Pallor present
No icterus/ cyanosis/clubbing/pedal
edema/generalised lymphadenopathy
ORAL HYGIENE
Poor
Dental caries present
HEAD TO FOOT EXAMINATION
No acanthosis nigricans
No irish nodes in the axilla
No seborrheic dermatitis
No markers of liver cell failure.
VITALS
Pulse rate;80/min, regular in rhythm, normal
volume and character, no vessel wall thickening,
no radioradial/ radiofemoral delay, felt in all
peripheral vessels
Blood pressure ; 110/70 mm Hg measured in
right upper arm in sitting posture
Respiratory rate: 17 per minute,
abdominothoracic
Temperature: afebrile
EXAMINATION OF ABDOMEN
After getting consent and explaining
the
procedure, the patient is exposed from
mid chest to mid thigh and examined
under bright light in supine position
INSPECTION
Abdomen : epigastric fullness seen, flanks free,
umblicus in midline, everted, no visible nodules in
periumblical region
All quadrants move equally with respiration
Visible gastric peristalsis seen
No visible mass/ pulsation
No scar, sinuses, dilated veins
No divarication of recti, external genitalia normal
Hernial orifices free
Supraclavicular fossa : no visible fullness
PALPATION
Not warm, not tender
A single mass 5*5 cm felt in epigastric region
extending 6cm below xiphisternum , 3cm above
umblicus, 3cm from midline towards left side and
2cm from midline towards right side
Surface: irregular, well defined margins, hard in
consistency, not mobile, moves with respiration
Rising test : swelling becomes less prominent
Lateral recumbent position: becomes more prominent
Plane of swelling: intra abdominal
Succussion splash present
No pulastion felt over mass
No cough impluse
No organomegaly
External genitalia normal
Left supraclavicular node ? not palpable
(TROISIERS SIGN negative)
Axillary lymph nodes not palpable
Para-aortic nodes not palpable
Inguinal nodes not palpable
MEASUREMENTS
Xiphisternum to umblicus-14 cm
Umblicus to pubic symphysis-12 cm
Spino umblical line-14cm on both sides
Abdominal grith-74 cm
PERCUSSION: no free fluid, impaired
resonance over mass
AUSCULTATION: normal bowel sounds
heard, no arterial bruit/ venous hum
AUSCULTOSERAPING :impaired
resonance
PER RECTAL EXAMINATION: to be
done
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM: normal vesicular
breath sounds heard and no added sounds
CARDIOVASCULAR SYSTEM: S1 S2 heard
and no murmurs
CENTRAL NERVOUS SYSTEM: no focal
neurological defect
Spine and Cranium : Normal
DIAGNOSIS:
Carcinoma stomach involving distal part
of stomach with symptoms of gastric
outlet obstruction
INVESTIGATIONS
BASELINE:
CBC, TC, DC, Hb%, ESR
Urine ? sugar, albumin
Blood- sugar, urea, creatinine
Blood grouping(A) and typing
Chest X-ray
ECG
Liver function test
Renal function test
SPECIFIC:
USG abdomen
Upper GI endoscopy(flexible)& biopsy
Barium meal
Contrast enhanced CT abdomen
Endoscopic ultrasonography
Diagnostic laproscopy
CT chest
Liver function test
PET scan
Tumour marker-CA724
Skeletal survey
TREATMENT :
Lower radical (subtotal) gatrectomy with
billroth II (roux-en-y) gastro jejunostomy
This post was last modified on 08 August 2021