Gastrointestinal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F1.jpg"}},{"insert":"\n\n"},{"insert":"Exhausted, you flop into your chair and glance at your watch: 08:57 AM.\r\n\r\nPerfect; a few minutes to recover from your journey. In hindsight, the height of summer might not have been the best time to start cycling to work.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F2.jpg"}},{"insert":"\n\n"},{"insert":"A couple of minutes later, you hear a knock on the door and call for the patient to come in.\n"}]}


{"ops":[{"insert":"\u0022Hello, doctor!\u0022. You see a familiar face come in.\r\n\r\nFifty-five-year-old Mr. Hassan comes to your clinic from time to time with routine complaints. However, you are more familiar with him as the owner of the most popular restaurant in town.\n"}]}


{"ops":[{"insert":"Mr. Hassan sits, taking a deep breath and rubbing his chest.\r\n\r\nYou greet him and exchange pleasantries before asking the reason for his visit today.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F5.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Well, I\u0027ve had horrible heartburn recently. My throat\u0027s been burning, and I feel like I\u0027m going to be sick each time I eat. I\u0027ve had chest pain so bad, I would swear I was having a heart attack.\u0022, he says.\n"}]}


{"ops":[{"insert":"You dig deeper and inquire when exactly the heartburn occurs. Mr. Hassan responds:\r\n\r\n\u0022Well, the heartburn comes just after I eat. Sometimes I wake up in the night with a similar pain in my chest. I\u0027ve been to the ER because of this, but all tests were normal.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F7.jpg"}},{"insert":"\n\n"},{"insert":"You note down what he has said, and move on to examining his diet and lifestyle.\r\n\r\n\u0022Well, I suppose I don\u0027t eat perfectly - I\u0027m so busy with the restaurant that I only really have time for a quick microwave meal in the evening or fast food. In fact, I\u0027ve put on almost 10 kg in weight over the last year.\u0022, Mr. Hassan responds.\n\n\u0022I try to eat in the morning, but I\u0027ll usually just have a coffee. I don\u0027t smoke or drink at all, for religious reasons.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F8.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Hassan was diagnosed with essential hypertension around 6 years ago. This is currently well controlled on amlodipine 5mg\/day.\r\n\r\nHe has no other comorbidities and is not on any other medications.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F9.jpg"}},{"insert":"\n\n"},{"insert":"On examination, Mr. Hassan\u0027s vital signs are normal and stable. You record his weight at 200 lbs (90.7 kg) and his height at 5\u0027 6\u0027\u0027 (1.68 m), giving him a body mass index (BMI) of ~32 kg\/m\u00b2.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F10.jpg"}},{"insert":"\n\n"},{"insert":"The general examination reveals dark striae in the hypogastric region, suggesting recent weight gain. Physical examination of the abdomen is unremarkable; you feel no organomegaly and find no abdominal masses.\n"}]}


{"ops":[{"insert":"The cardiorespiratory examination is unremarkable as well.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M54_F5.jpg"}},{"insert":"\n\n"},{"insert":"What is your provisional diagnosis?\n"}]}
1. Gastroesophageal reflux disease
2. A gastric ulcer
3. Diffuse esophageal spasm