CASE 81: ABDOMINAL PAIN
History
A 38-year-old man has a 2-month history of abdominal pain. The pain is epigastric or cen-
tral and is intermittent. He had a similar episode a year before. On that occasion he took
some indigestion mixture obtained from a retail pharmacy, and the symptoms resolved
after 10 weeks. The pain usually lasts for 30–60 min. It often occurs at night, when it can
wake him up, and seems to improve after meals. Some foods such as curries and other spicy
foods seem to bring on the pain on occasions.
He has smoked 10–15 cigarettes per day for 25 years and drinks around 30 units of alco-
hol each week. He is not taking any medication at present. There is no other relevant med-
ical history. He works as a financial broker in the City. He has been feeling more tired
recently and had put this down to pressure of work. A blood count was sent.
Examination
There is mild tenderness in the epigastrium, but no other abnormalities.
NormalHaemoglobin 10.2 g/dL 13.3–17.7 g/dL
Red cell count 6.4% 1012 /L 4.4–5.9% 1012 /L
Mean corpuscular volume (MCV) 71 fL 80–99 fL
White cell count 8.9% 109 /L 3.9–10.6% 109 /L
Platelets 350 % 109 /L 150–440% 109 /L
Iron 4 mmol/L 14–31 mmol/L
Total iron-binding capacity 76 mmol/L 45–70 mmol/L
Ferritin 6 mg/L 20–300 mg/LThe blood film is reported as showing microcytic, hypochromic red cells.INVESTIGATIONS
Questions
- How do you interpret these findings?
- What is the likely diagnosis and how should it be confirmed?