CASE 60: WEIGHT LOSS
History
A 67-year-old man attends his general practitioner’s (GP’s) surgery. He says that he has
lost 10 kg in weight over the last 4 months. This has been associated with a decrease in
appetite and an increasing problem with vomiting. The vomiting has been productive of
food eaten many hours previously. During the last month he has noticed some weakness,
particularly in his legs, climbing hills and stairs.
He is a smoker of 20 cigarettes per day and drinks around 10 units of alcohol each week.
There is no relevant family history. His past medical history consists of hypertension which
was treated for 2 years with beta-blockers. He stopped taking these 4 months ago.
Examination
He looks thin and unwell. His pulse is 82/min. His blood pressure is 148/86 mmHg. There
are no abnormalities to find on examination of the cardiovascular and respiratory systems.
There are no masses to feel in the abdomen and no tenderness, but a succussion splash is
present.
NormalSodium 130 mmol/L 135–145 mmol/L
Potassium 3.0 mmol/L 3.5–5.0 mmol/L
Chloride 82 mmol/L 95–105 mmol/L
Bicarbonate 41 mmol/L 25–35 mmol/L
Urea 15.6 mmol/L 2.5–6.7 mmol/L
Creatinine 100 &mol/L 76–120&mol/L
Calcium 2.38 mmol/L 2.12–2.65 mmol/L
Phosphate 1.16 mmol/L 0.8–1.45 mmol/L
Alkaline phosphatase 128 IU/L 30–300 IU/L
Alanine aminotransferase 32 IU/L 5–35 IU/L
Gamma-glutamyl transpeptidase 38 IU/L 11–51 IU/LFull blood count: normal
Chest X-ray: clearINVESTIGATIONS
Questions
- What is the likely explanation for these findings?
- What is the most likely diagnosis?