A 66-year-old woman, a retired nurse, consults her general practitioner (GP) with a 4-month history of tiredness, slight breathlessness on exertion and loss of weight from 71 to 65 kg
History
A 66-year-old woman, a retired nurse, consults her general
practitioner (GP) with a
4-month history of tiredness, slight breathlessness on exertion and loss of
weight from 71
to 65 kg. Her appetite is unchanged and normal, she has no nausea or vomiting,
but over
the last 2 months she has had an altered bowel habit with constipation
alternating with
her usual and normal pattern. She has not seen any blood in her faeces and has
had no
abdominal pain. There is no relevant past or family history, and she is on no
medication.
She has smoked 20 cigarettes daily for 48 years and drinks 20–28 units of
alcohol a week.
Examination
She has slight pallor but otherwise looks well. No
lymphadenopathy is detected, and her
breasts, thyroid, heart, chest and abdomen, including rectal examination, are
all normal.
The blood pressure is 148/90 mmHg.
Questions
• What is the likeliest diagnosis?
• How would you investigate the patient?
Question-answer
Current clinical finding;
·
The investigations
show microcytic, hypochromic anaemia.
·
premenopausal woman
-excessive menstrual blood loss.
·
postmenopausal women
the most likely cause would be lost from the gastrointestinal tract.
·
This woman has an
altered bowel habit, which suggests a problem with the lower gastrointestinal
tract and a diagnosis of carcinoma of the colon, which would also explain her
weight loss.
Investigation:
·
Carcinoma
of the colon is increasing in
frequency. If it presents at an early stage, then the prospect for cure is
good. Rectal bleeding, alteration in bowel habit for longer than 1 month at any
age, or iron-deficient anaemia in men or postmenopausal women are indications
for investigation of the gastrointestinal tract. In younger people, there may be
a hereditary element to carcinoma of the colon.
·
Smoking is a risk the factor for carcinoma of the colon.
·
Various clinical test like SGPT,
SGOT, Vitamin-k and other liver function test should be used to investigate the
cause and severity of the hepatic inflammation or hepatic cirrhosis.
Hepatoprotective drug-like silymarin obtain from salibum meryanam my be
recommended.
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