1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Jason Rexroad Affiliation: Civilian Medical Center

2. MedPix No: 5347 - History Pt Demographics: Age = 56 y.o. Gender = woman The patient is a 56 year-old diabetic woman with a long-standing history of gastroesophageal reflux disease, now presenting with symptoms of bloating. Downloaded by (-1)

3. MedPix No: 5347 - EXAM & LABS H.pylori negative; poorly controlled diabetes.

4. Delayed Gastric Emptying Images from a Tc99m-sulfur colloid gastric emptying study show visually delayed gastric emptying as well as delayed clearance of radiotracer from the stomach when compared to an established nomogram (nomogram also included as the second of the two submitted images). Downloaded by (-1)

5. Delayed Gastric Emptying Images from a Tc99m-sulfur colloid gastric emptying study show visually delayed gastric emptying as well as delayed clearance of radiotracer from the stomach when compared to an established nomogram (nomogram also included as the second of the two submitted images). Downloaded by (-1)

6. FINDINGS Images from a Tc99m-sulfur colloid gastric emptying study show visually delayed gastric emptying as well as delayed clearance of radiotracer from the stomach when compared to an established nomogram.

7. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Delayed gastric emptying of acute onset: pain, cold, medications, ileus, viral gastroenteritis, and metabolic derangements such as hyperglycemia and hypokalemia. - - Chronic causes of delayed gastric emptying: gastric outlet obstruction, postvagotomy state, gastric ulcer, chronic idiopathic intestinal pseudoobstruction, gastroesophageal reflux, diabetes mellitus, amyloidosis, and uremia, to name a few

8. Diagnosis: Delayed Gastric Emptying, likely secondary to diabetic gastroparesis. Dx Confirmed by:

9. DISCUSSION Please see factoid.