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Gastrointestinal: weight loss

Mr Brown is a 67 year old gentleman who presents to his GP. He has not been to his GP in a long time, but he recently noticed when shopping for new clothes, as his old clothes were feeling looser, that he was more tired than usual. This had been going on for some time. He also had some alternating bowel habits over the last few months, but did not feel too worried as he had not passed any blood. What is the most important differential for the GP?


Mr Brown mentions that his brother had a polyp after he was invited for a screening test in the mail. He asks if this kind of test would be a good idea for him to have. Why is the screening test (looking for faecal occult blood) not useful for Mr Brown?

The GP finds recent blood results for Mr Brown showing Hb at 11.4g/dl, MCV at 65fl and platelets at 230. What do the bloods indicate?

Keyboard users: tab to the item you want to relocate, press enter to select, use left and right arrows to pick category, and up and down arrows to choose position, then press enter again to confirm.

  • Small bowel obstruction
  • Altered bowel habit
  • Weight loss
  • PR bleeding
  • Tenesmus
  • Altered bowel habits
  • Large bowel obstruction
  • Fresh PR bleeding
  • Iron deficiency anaemia
  • Mucus PR
  • RIF mass


Keyboard users: tab to the item you want to relocate, press enter to select, use left and right arrows to pick category, and up and down arrows to choose position, then press enter again to confirm.

  • 1% 5 year survival
  • 30-40% 5 year survival
  • Penetrated bowel wall
  • Limited to bowel wall
  • Distant metastases
  • 65-75% 5 year survival
  • 95-100% 5 year survival
  • Lymph node metastases



 
Fortunately Mr Brown's cancer does not come back and the only evidence that remain are the abdominal scars.
 
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polyp-2.jpeg

Polyp seen on colonoscopy. This can be removed with the same instrument by use of snare cauterisation. © 2009 Dr FC Turner.


























Colonoscopy showing a large malignant poly.
















Video showing a laproscopic sigmoid colectomy.



For those so inclined.