Case 1:

A 47-year-old male construction worker is seen in your office because of epigastric pain, a twenty pound weight loss over the past two months, weakness, and exertional dyspnea. The weight loss has been gradual over the past two months, but the weakness and dyspnea have occurred over the past three weeks and has been getting worse. The pain is described as a burning sensation and is located primarily in the epigastrium and does not radiate. The pain has been continuous over the past weeks, is aggravated by food and alcohol and is temporarily relieved with over the counter antacids and acid reducers. The pain often awakened the patient from sleep. The patient denies dysphagia and odynophagia but admits to decreased appetite. His stools have been brown in color but over the last two days he noticed several back, tarry, malodorous, sticky stools.

The patient describes his past health as excellent and has rarely seen physicians. The review of systems is negative. No prior hospitalizations. No surgery, No allergies. No chronic medication use.

Physical examination revealed a well-developed, well-nourished male whose vital signs were as follows: Supine: B/P=140/70, P=98; Sitting: B/P=110/64, P=130; R=14; T=37; Weight = 185 pounds. The physical examination was normal except for moderate tenderness to deep palpation over the epigastrium, no hepatosplenomegaly, Grade II harsh ejection murmur at the cardiac apex; rectal exam is negative, and no stool in the vault.

A CBC and Chemistry profile done in your office reveals the following:

CBC:   Hgb-9.5 gm/dl, Hct=28.5%, WBC-5, 800 (normal differential) Platelets-240K, Microcytic, hypochromic red cells on peripheral smear.

Chem. Profile:   All values normal except, albumin=2.8 gm/dl, cholesterol=160 mg/dl.