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  #1  
Old 04-23-2011
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GIT Upper GI Pathology Question

A 75-year-old Japanese woman reports repeated episodes of vomiting of undigested food mixed with blood. She has lost 5 kgs in weight over the last one month. Clinical examination shows a frail woman with mild conjuctival palor. On examination, you feel a non-tender slightly mobile mass in the epigastric region.

Which one of the following is the most appropriate method of investigating the patient?
A. Barium Swallow
B. Upper gastrointestinal tract endoscopy
C. Abdominal ultrasound
D. MRI
E. CT Scan
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Old 04-23-2011
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Another good question!
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Old 04-23-2011
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Originally Posted by add1 View Post
The answer would be upper GI tract endoscopy.
are u sure its safe with the bleeding?

sorry but i dont have the answer to this question.
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Old 04-23-2011
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Yes. Upper GI endoscopy!

Also useful to stop bleeding inaddition to visualise tumor/take biopsy!
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Old 04-23-2011
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Yes. Upper GI endoscopy!

Also useful to stop bleeding inaddition to visualise tumor/take biopsy!
hmm... ok... ill have to look into reading more about endoscopy then. cos i was sure barium swallow cannot be used cos she'll vomit it. so i tot perhaps a ct scan in case she had a tumor it would be perfect too.
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Old 04-23-2011
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" upper GI endoscopy" my answer.... this question was so simple
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Old 04-23-2011
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best answer is Upper GI endoscopy.......it's a case of gastric cancer not esophagus ....mass is in epigastrium......most probably pyloric antrum is involved......so symptom is vomiting ......and for diagnosis of gastric carcinomas we don't use barium swallow ...we use barium meal ...barium swallow is for esophagus only ......so A option is wrong....plus with endoscopy we can visualize the tumor well and take biopsy.........
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Old 04-23-2011
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Default gastric cancer

JAPAN JAPAN- WEIGHT LOSS -EPIGATRIC PAIN - gastric cancer get a biopsy fast and tell her to stop eating all this smoked fish
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Old 04-23-2011
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Originally Posted by Seetal View Post
hmm... ok... ill have to look into reading more about endoscopy then. cos i was sure barium swallow cannot be used cos she'll vomit it. so i tot perhaps a ct scan in case she had a tumor it would be perfect too.
If you see a mass on CT wouldn't we still want to biopsy it? With the EGD, we can look at and biopsy it... I think that there is very little danger of causing more damage with the endoscope (questions assume an experienced operator, right?).
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Old 04-24-2011
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Well I'd go for barium swallow first as the next most appropriate step for investigating a suspected gastric lymphoma ,, The most appropriate next step then is to do upper GI endoscopy for biopsy ,, then a CT of the abdomen trying to figure out the extent of the tumor across the gastric wall ,, the rational here is that when we start chemotherapy for which the tumor is highly sensitive , the stomach wall will undergo lysis of the tumor leading to gastric perforation so the most important step after diagnosis confirmation is to determine the extent of the tumor across the gastric wall ,
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