1. SURGERY GRAND ROUND GASTRIC CARCINOMA

2. Demographics Name: MP Age/Sex: 42yrs/M Add: Mirambi, Ibanda Occupation: Peasant farmer NOK: BA (brother) DOA: 16 th /12/2014 Refer in:.......................

3. HPC Epigastric mass 3/12 and Abdominal pain 1/12 HPC Initially: noticed a non-painful neck swelling, then an epigastric mass. Later: progresssive epigastric pain: radiating to the flanks, non- collicky. Vomiting all feeds 30 min post feeding and weight loss. NONE: difficulty in swallowing, cough, other B-symptoms, DIB, yellowing of eyes, fever, loose stool, hematemesis nor malaena

4. PMHx Index admission, NYU, Known PUD patient*5years on& off Rx No other known chronic illness PSHx No h/o BT, fractures or major surgical intervention FSHx Social drinker * 40 years Smokes pipe * 29 years Married with one wife (4 children); none else with cancer.

5. Clinical exam G/E : Middle aged, wasted, J +, A ++, C 0, C 0, T 36.4 O C LN: Axillary, Cervical, Virchow’s node P/A Scaphoid with a fixed, tender epigastric mass No colateral vessels or scars No other palpably enlarged organomegaly Shifting dullness & Succusion splash: -ve Normal bowel sounds

6. Clinical exam R/S : Not in distress, RR=18b/m. Normal chest findings. CVS Warm extremities; HS I+II+0; Regular and normal vol. pulse; PR=98 bpm BP=126/78mmHg OTHER systems: NORMAL

7. Diagnosis Gastric cancer  Moderate anaemia  Metastases  Gastric outlet obstruction Differentials Esophageal cancer Pancreatic, gall bladder, liver tumours

8. Investigations: Blood: CBC (HB 4.3 g/dL, MCV 62.0fL), thin /peripheral film (Marked hypochromasia with dominant microcytes, normal platelets), RFTs, LFTs, RCT(NYN) Abdominal USS: Regular hyperechoic mass attached to the left liver lobe 5.60*5.57*9.01 cm. Other organs are normal

9. Investigations: Barium meal Filling defect in the body of the stomach; approx. 23*24mm. Loss of continuity of Barium in the duodenum and distal GIT. UGI Endoscopy: Normal oesophagus and cardia. Hyperaemic and easily bleeding lesion; 2*3*2cm in the body of the stomach. Biopsy of the lesion taken Pylorus has reduced patency. Histology: Moderately differentiated adenocarcinoma with areas of poor differentiation; diffuse pattern.

10. Diagnosis Advanced gastric adenocarcinoma  Moderate anaemia  Metastases  Gastric outlet obstruction

11. Management Admitted and Resuscitated: Tranfused with three units of blood I/V fluids Oral haematinics Analgesia Exploratory laparotomy plus by-pass surgery was done Patient linked to the oncology unit for chemotherapy and follow up. Discharged with considerable improvement

12. k APWOYO MATEK TUTWAL BED MABER DR. JJINGO