26

Case 26


History



A 64-year-old gentleman who is an ex-heavy smoker and chronic drinker presents with painless progressive dysphagia over the past few months. There is also weight loss and a decrease in appetite. He denies any symptoms of gastrointestinal bleeding.


Physical examination


Afebrile, pulse 80 bpm, BP 120/80mmHg, SaO2 98-100% on RA.


Hydration is satisfactory.


Examination of the hands reveals no clubbing and normal-appearing palmar creases.


Head and neck examination is unremarkable.


Cardiovascular: HS dual, no murmur.


His chest is clear on auscultation.


Abdominal examination reveals a soft, non-tender abdomen, with no peritoneal signs.


No signs of oedema.


Investigations


CBC:


WBC 8.2 x 109/L;


haemoglobin 12.5g/dL;


platelets 294 x 109/L.


Urea 4.6mmol/L.


Liver function tests are normal.


Renal function tests are grossly unremarkable.


Clotting profile is normal.


What further investigation would you perform?


In view of the symptoms of dysphagia associated with mild anaemia, an oesophagogastroduodenoscopy (OGD) is warranted (Figure 26.1).






images


Please describe what you see


A circumferential ulcerative obstructing tumour growth is noted in the mid-oesophagus. The 9.8mm endoscope could not pass; therefore, a 5mm nasoendoscope is used, which is able to negotiate past the obstructing tumour, revealing that the tumour spans ~10cm (from 24cm to 34cm from the incisors). Multiple biopsies are taken.


What would you do next?


In view of the obstructing tumour with symptoms of dysphagia, an endoscopy-guided feeding tube is inserted to provide nutrition.


The following is a histological photo (Figure 26.2).






images


Please describe what you see

Only gold members can continue reading. Log In or Register to continue

Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 26
Premium Wordpress Themes by UFO Themes