a 56-year old male farmer from laguna is admitted because of an abdominal mass. history of the...
DESCRIPTION
A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness: - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/1.jpg)
![Page 2: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/2.jpg)
A 56-year old male farmer from Laguna is admitted because of an abdominal mass.
History of the Present Illness: • 5 months PTA, he noticed gradual abdominal enlargement and a
palpable abdominal mass. This was accompanied by a feeling of abdominal fullness and early satiety. He also noticed weight loss of around 10 lbs.
ROS: Unremarkable
![Page 3: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/3.jpg)
Personal History:
• The patient smokes around 10-15 sticks of cigarettes a day for the past 20 years. He drinks 2-3 bottles of beer every day.
• He has had no previous hospitalization.
Physical Examination:
• BP 150/90; PR 78 bpm; RR 15 cpm; Temp 36.7; Weight: 130 lbs; Height: 5 ft 7 in
• HEENT - pinkish palpebral conjunctivae; no palpable cervical lymph nodes
• Heart and Lungs: essentially unremarkable
![Page 4: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/4.jpg)
• Abdomen: palpable mass at the periumbilical area with a smooth surface, non-tender, with ill-defined borders, measuring around 10 cm at its widest diameter. It is also not ballotable and does not move with respiration. Bowel sounds are normal.
• Rectal exam: ⊖
Admission Work-ups:
– Blood tests
• Hemoglobin 130, Hematocrit 40, WBC 8000/cumm; PMN 70, lymphocytes 25, eosinophils 5
• Total Protein 75, Albumin 55, Globulin 20
• PT: 13 sec, Control 12 sec; APTT: 40 sec
![Page 5: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/5.jpg)
– Chest x-ray – normal
– CT scan of abdomen:
![Page 6: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/6.jpg)
• On the 2nd hospital day, he undergoes a diagnostic procedure. Histopath is shown below:
![Page 7: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/7.jpg)
• On the 4th hospital day, he undergoes surgery. Operative findings:
– A 15-cm encapsulated mass is found located at the retroperitoneum adherent to the ascending colon. The tumor does not involve the aorta nor the inferior vena cava.
– Liver is normal
– Resection of the tumor with R hemicolectomy is done.
![Page 8: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/8.jpg)
• Histopathology of the resected tumor shows the following after special staining:
![Page 9: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/9.jpg)
• Post-operative course is uneventful. • Eighteen months after surgery, he comes back
complaining of persistent cough with weight loss. Chest x-ray and Chest CT scan are done and show the following:
![Page 10: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/10.jpg)
Salient features
Subjective salient features:• gradual abdominal enlargement and a
palpable abdominal mass • feeling of abdominal fullness and early satiety• weight loss
![Page 11: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/11.jpg)
Salient featuresObjective Salient features:
• palpable mass at the periumbilical area with a smooth surface, non-tender, with ill-defined borders, measuring around 10 cm at its widest diameter. It is also not ballotable and does not move with respiration.
• Total Protein 75, Albumin 55, Globulin 20
• PT: 13 sec, Control 12 sec; APTT: 40 sec
![Page 12: A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the Present Illness:](https://reader036.vdocuments.us/reader036/viewer/2022062814/568167f5550346895ddd6fb5/html5/thumbnails/12.jpg)
Salient features
• Operative findings: 15-cm encapsulated mass located at the retroperitoneum adherent to the ascending colon. The tumor does not involve the aorta nor the inferior vena cava.