Cases

Question 1

A patient presents after vomiting coffee grounds. His endoscopy shows a 3cm punched-out ulcer in the antrum. What is your diagnosis?

Answer 1

Chronic peptic ulcer disease.

Key words: Punched out ulcer and vomiting coffee beans

Question 2

A 63 year old lady presents to your surgery with weight loss, epigastric pain and anorexia. On endoscopy you see a thickened gastric wall and on biopsy there are signet ring cells within the mucosa. What is your diagnosis?

Answer 2

Adenocarcinoma

Key words: Thickened gastric wall and signet ring cells.

Question 3

A 51 year old female presents to your surgery looking clearly unwell; she is thin, pale. She tells you she hasn’t been eating well recently and has noticed a large amount of weight loss. On examination she has a swollen abdomen, signs of pleural effusion, dullness in the abdomen and hepatomegaly. Her CXR confirms the effusion and multiple opaque patches within the lungs.
What is your diagnosis?

Answer 3

Malignancy

She has malignancy that has metastasised to the liver and lungs. The most likely cause is ovarian cancer.