Gastroenterology
Case 34: A Patient with Epigastric Pain and Weight Loss
CASE
A 58‐year‐old man presents on the medical admissions ward with a 3‐month history of epigastric pain and 12 kg in weight loss. He had previously been a very heavy drinker but had cut back recently due to his pain and vomiting. He has experienced diarrhoea, passing a pale and offensive stool 4–5 times a day. He has had marked thirst and nocturia.
On examination he looks dehydrated and unwell. His pulse is 100 beats/min, and his BP 110/60 mmHg. He smells ketotic. Abdominal examination demonstrates upper abdominal tenderness but no palpable mass, no organomegaly and no ascites.
Blood tests showed:
Hb 11.2 g/dL MCV 105 fL WCC 14.8 × 109/L Platelets 380 × 109/L Glucose 22.3 mmol/L Na 128 mmol/L K 3.1 mmol/L Urea 22.4 mmol/L Creatinine 110 µmol/L Albumin 28 g/L Bilirubin 12 µmol/L ALP 170 U/L AST 46 U/L Amylase 45 U/L Urine dipstick showed: Ketones ++ Blood – Protein –
QUESTION 1
Your score this session: 0 of 0
His ‘diarrhoea’ is most probably due to: