Epigastric pain
Chief Complaint A 38 y/o male presents with pain in the epigastric region for 6 months. He does not have dysphagia but not able to eat properly because of pain & lost 4 kg in last 4 months. Examination Mild tenderness in epigastric region noted. Rest of the physical examination is unremarkable. Investigations Blood report negative for H. pylori. Radiographic examination - normal. EGDS & Colonoscopy shows many diffuse polypoid lesions in the stomach ileum. Treatment How should we move forward with the case?
Site of polyposis is stomach ileum is confusing if noticed at both sites in EGDS and colonoscopy than it is most likely familial and needs to submit for biopsy and HPE to r/o malignancy as there is h/o weight loss
An upper G.I endoscopy should have been accompanied by a biopsy to proceed further. It could be a familial polyposis syndrome. GIST also needs to be ruled out . These polyps- may have the potential to turn malignant. Meanwhile- liq,sucralfate, PPI, prokinetic and enzyme preparation can be started till biopsy report comes
Multiple polyps seen in common carries high chance of malignancy Polypectomy and histopathology is important to look for adenomatous polyposis and dysplasia/ malignancy Epigastric pain and loss of appetite could be because of acid peptic disease PPI with motility agent Pantoprazole 40 mg once daily with Itopride 50 mg one tablet three times a day
Upper GI endoscopy with biopsy and other investigation and evaluation to conclude. Malignancy can be ruled out. Avoid oily spicy and fast food. Antispasmodic ORALLY. Gulusil MPS + Unizyme syp 3tsf TDS. Stalabid 2 TDS to reduce Intestinal mobility.
History in favor of neoplastic peptic ulcer Polypoid lesion Biopsy HP Pets can Cea1 Opinion of oncologist
ADVISABLE.. BIOPSY.. RULE OUT TUBERCULOSIS ( IF. COLONOSCOPY ) DD MALIGNANT. CHANGES
What does the HPE say?
- Again Endoscopy C Bioscopy Check For FAP Syndrome?
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