Question

Case Analysis

Ana, a 40-year-old businesswoman, went to a clinic for a check-up. She complained of persistent abdominal pain, fever, and vomiting episodes. Upon physical examination, her temperature and pulse rate was 38.5C and 75 bpm, respectively. Further, the attending physician noticed the presence of raised, reddish-yellow bumps or nodules on her skin and the tenderness of her abdomen. Upon further interview, the patient admitted that the abdominal pains were recurrent, and she did not bother having herself checked until the pain became unbearable. Her clinical records showed that the has type 2 diabetes mellitus. Her sister suffered from the same complaint and died two years ago. The physician requested the performance of lab tests. The results are shown below:

Result Reference Range Name of Test Clinical Chemistry Triglyceride 45.2 mmol/L 0.11 - 2.15 mmol/L Total Cholesterol 4.3 mmol/L <5.2 mmol/L LDL-C <2.6 - 3.35 mmol/L 2.5 mmol/L 1.60 mmol/L HDL-C >1.56 mmol/L 556 U/L 30 - 220 U/L 0.25 umol/L/min 21.2 - 47.6 umol/L/min 0.26 umil/L/min Serum amylase LPL activity (pre heparin treatment) LPL activity (post heparin treatment) Glucose (Random) Hematology Complete Blood Count 21.2 - 47.6 umol/L/min 13.9 mmol/L 4.4-7.8 mmol/L 4.6 x 1012/L RBC count 4.1-5.1 x 1012/L Hematocrit 0.389 L/L 0.359-0.446 L/L Hemoglobin 145 g/L 123-153 g/L MCV 88 fL 80-96 fL MCH 30 pg 27.5-33.2 pg

1. What is the most probable diagnosis of this patient? Why?

2.What other test/s is/are recommend to confirm diagnosis further?

3. This disease has almost a similar clinical picture with a specific disease.

What is that specific disease, and how will you differentiate the two?

4. What is the cause of this disease?

This is for diagnostics.

Answer 1

Patient Ana is suffering from a persistent abdominal pain.and also she is diabetic positive,on physical examination tender abdomen and also elevated levels of triglycerides,serum amaylase etc..,

1. Cancer

Why beacuse patient had persistent abdominal pain and bumps and modules over skin that means her lympatic/integumentary system show abnormality.so it may be cancer.

2.routien tests are given here,but here ultrasound abdomen or CECT-abdomen is useful for to diagnose and also tumour markers like CA 125,Carcino embroynic antigen flow cytometry&cardiac fitness also,incase if the patient is affordble full body scan is useful for diagnosis as like as PET scan.

3.Cancer/gastro intestinal disease

4.family history of cancer

• Gastro intestinal disease
• Obese
• Diabetic/hypertension
• Long term stomach pain or inflammation
• Tender in abdomen
• Fatty liver
• Low physical activity etc..