Case CA Stomach

SURGERY
CASE PRESENTATION
HIBA AT
BIODATA
• Name :Gangadharan
• Age:52
• Sex:male
• Address:Kondotty
• Profession: Shopkeeper
• History was obtained from patient
and found to be reliable
PRESENTING COMPLAINTS
• Abdominal pain :2months
• Vomiting:2 weeks
HISTORY OF PRESENT ILLNESS
Patient was apparently normal 2months
back when he developed pain in the upper
part of his abdomen ,which was gradual in
onset and noticeable more after taking the
food and was a dull aching type of pain .
There was no radiation of pain .He took
some medication for pain but pain was not
relieved and was progressive over time
• For the past 2week he started developing
vomiting which was projectile and non
bilious,occurs within an hour of consuming
food and it contain undigested food
particles , occassionally associated with
coffee ground colour.There was no relief
from pain after vomiting.
• He also has feeling of early satiety for past 2

weeks.
• He also complains that recently his clothes
become loose and not fit as previously it used to
be
•No h/o yellowish discoloration of skin ,eye, urine
•No h/o malena, diarrhoea
•No h/o abdominal distension,pedal edema
•No h/o backache, hemoptysis
breathlessness ,palpitation ,headache
•No h/o fever
PAST HISTORY
• He had a history of pulmonary
tuberculosis 5years back for which he
took the medication for 6months
• He is diabetic and on OHA for past 10
years . No h/o HTN
• No history of CAD , bronchial asthma
• No h/o gastric ulcer
• No history of any surgery done in the past
PERSONAL HISTORY
• Non vegetarian diet
• There is reduced food intake due to
pain and vomiting
• Normal bladder habits with reduced
bowel movements
• Sleep is normal
• He is a smoker with smoking index 150
• Alcohol consumption occasionally
FAMILY HISTORY
• His mother is diabetic and father
died due to coronary artery disease
• No h/o any malignancy in family
SOCIOECONOMIC STATUS
• He lives in a concrete roofed home
with well water as source of water
• Belongs to a poor family
GENERAL EXAMINATION
Examined in a well lit room with adequate exposure and
privacy with informed consent.
Patient was lying in the bed looks tired and cachexic

•Conscious, oriented ,cooperative
•Poorly built and nourished
•BMI:18.3
•Pallor present
•No icterus, cyanosis, clubbing,
•No generalized lymphadenopathy .No left
supraclavicular or left axillary lymph node enlargement.
•No pedel edema
• No thyroid swelling and varicose vein
• Hair and nail appears to be normal
• Skin appears to be dry , no tripe palm, acanthosis
nigricans or seborrheic keratosis visible
Vitals
• Pulse:70/min , regular rhythm and character,
normal volume , no vessel wall thickening,no
radiofemoral delay, all peripheral pulsation felt
equally on both sides
• BP: 110/70mmHg right arm, supine position
• Respiratory rate:16/min, Abdominothoracid
• Temperature:Afebrile
ABDOMINAL EXAMINATION
•Patient is examined in supine position with legs semiflexed
•, in a well lit room with adequate exposure from
xiphisternum to the mid thigh with proper consent
•INSPECTION
•Contour of abdomen is scaphoid
•Corresponding quadrants move equally with respiration
•Skin over abdomen is normal without sinuses, scars,dilated
veins
•No epigastric fullness noted
•Umbilicus was central, inverted ,no nodules seen over
umbilicus
• No visible gastric peristalsis
• No visible pulsations
• Hernial orifices normal
• External genitalia normal
• Inspection of spine:no visible deformity
• No paraspinal sinuses
• No renal angle fullness
• Left supraclavicular LN not visible
PALPATION
• No local rise of temperature and tenderness

• No guarding or rigidity for the abdominal muscles
• Abdominal swelling
A swelling is palpable in the upper abdomen in
epigastric area of size 6×4cm ,oval in shape and
well defined margins, irregular surface,hard in
consistency, extending from 2cm below
xiphisternum to 5cm above umbilicus. Swelling
move with respiration and also has intrinsic
mobility.
• Plane of the swelling was intra abdominal
•Transmitted pulsation was obtained in epigastric
area
• No other mass obtained in abdomen,
No organomegaly
• External genitalia normal
• Hernial orifices normal
• Skull and spine : no tenderness
• Renal angle no tenderness
• PR examination not done
PERCUSSION
• Impaired resonance of the swelling
• Shifting dullness was not
demonstratable for the patient
• No evidence of free fluid in
abdomen
AUSCULTATION
• Normal bowel sound
• Auscultopercussion
Border of stomach was not
reaching until umbilicus
• Succusion splash not done
EXAMINATION OF OTHER SYSTEM
• Respiratory system
Normal vesicular breath sound
heard in all lung areas
• No dullness on percussion obtained
in lung areas
• Cardiovascular system
S1and S2 normal no added sounds
or murmur
• Nervous system
HMF normal , sensory and motor
system within normal limit
SUMMARY
• Gangadharan a 52year old male from a poor
socioeconomic status,with a habit of smoking and
occasional alcohol consumption and past h/o TB
and diabetes on OHA for past 10yrs presented with
pain in upper abdomen for past 2month after
taking food and non bilious projectile vomiting
immediately after food intake for 2week .On
examination pallor present and an intra abdominal
oval mass of 6×4cm at upper epigastrium ,
hard,move with respiration and has intrinsic
mobility with impaired resonance
Diagnosis of case
• Mass in abdomen with origin most
likely being stomach probably
Carcinoma of stomach with gastric
outlet obstruction without
metastasis.

Case CA Stomach

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SURGERY

• He also has feeling of early satiety for past 2

Patient was lying in the bed looks tired and cachexic

• No local rise of temperature and tenderness

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