A 67-year-old widow was presented to a walk-in clinic with gradually increasing

Question

A 67-year-old widow was presented to a walk-in clinic with gradually increasing tiredness and easily get shortness of breath after routine activitios such as cooking or walking her dog. Two years earier she had been found to be anemic and had been troated with oral iron without symptomatic improvement Since 5 years ago, sometimes she has heartburn feeling in the abdomen, especially when she missed her meals or under a lot of stress. Usually those symptoms will subside after she take over the counter Alka-Seltzor or similar medications. She had history of blood loss in her foces. She complains of general tiredness since 2 years ago although she said that she always tries to eat healthy lots of vegetables and fruits, although she avoids red meats because she thought they are bad for her. She is a widow, her husband passed away 2 years ago due to motor vehicle in a one bed room apartment with her dog. She is a retired kindergarten teacher lost 6kg in weight in the last year, but denied any accident. She has 3 grown-up children, all healthy and have been married and all live in different cities than her. She lives by herself Physical exarh Temperature: 37° Celsius (normal: 36.10.37.2 Blood pressure: 120/80 mmHg (normal: 120/80 mmiHg) Heart rate: 105 beat/minute (normal 60-100 x/minute) · Respiratory rate: 15/minut(normal 12-20 x/minute) Upon inspection she looks very pale, skinny woman, her conjunctiva are also very pale. Heart: regular heart beat with murmurs. bdoment a slight discomfot upon pressure of her upper abdomen where her stomach is located. Lung: clear on auscultation. Other physical exam is normal. ·

Explanation / Answer

Some of the symptoms that we can enlist by looking at the case history of the patient are-

- General tiredness

- Shortness of breadth

- Anemia

- Continuous inflammation or pain in abdomen since five years

- Weightloss even after consuming healthy diet.

Also the patient is a female and is 67 years old.

Based on above symptoms, sex and age of the patient, the possible diagnosis that comes to mind is gastrointestinal (GI) or stomach cancer.

Since patient hasn't reported any vomiting or blood in the stool (which are advanced symptoms of GI cancer) so it is possible that she might not have gone into advanced stage of cancer yet.

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