abdominal pain

presenter: isya
dr Mular

52 yr old chinese gentleman was admitted on 11/7/11 at 4B

problem lists:
1)abdominal pain 3/52
3 weeks duration of progressingly worsening and fluctuating squeezing pain at the upper abdomen.
the pain disturbing patient sleep with no aggravating and relieving factor.
3 days PTA, loose stools and tenesmus
associted with LOA & LOW and progressively become lethargy.
no nausea, no vomiting, no PR bleed, no jaundice, no pale colored stool

2)low grade fever 3/52
intermittent
fever at evening and night,relieved by PCM

no hx of blood transfusion, no tatto

history of multiple sexual partners, and sexual partner with multiple sexual partner

had color vision deficit, red-green, otherwise no DM, no HPT no Asthma.

past surgical/drug/allergy-nil

past family hx: both parents die due to cx of DM and HPT.no fhx of malignancy

social hx: married with 3 children, A&W
smoke for 60 pack-year
consume alcohol for 20 yrs(2 bottle of beerx2/week)
working as mechanic with income of 2k-3k

0/E
pt well, pink orientated to TPP, no in respiratory difficulty, not complaining any pain

vital signs normal

abdominal examination:
distended epigastric and periumbilical
soft abdomen, tenderness over the epigastric, RHC,r.lumbar and RIF.
firm liver mass,6cm from costal margin, smooth surface with prominent hard nodule at the epigastric region, tender, no bruit
liver span:16cm

spleen, kidney, not palpable.

no ascites

normal bowel sound

refused for DRE

CVS, respi-normal

Differential dx:

1: 2ndary mets to the liver from gi
more common than primary
hx of loa,low
liver mass

2. primary liver ca
loa, low
liver mets
risk for hepatitis

3.pyogenic liver abscess
tender liver mass.

4.hemangioma of the liver

5. benign liver tumor

6. liver cyst

ix:

blood ix:
1. fbc tro inflammation/infection
2. LFT
3. CEA
4. AFP

imaging
1.abdominal u/s
2. CT scan

diagnosis
1. liver mets fr GI malignancy
2. diverticulis