Ca Stomach

Under the guidance of

Professor Dr J A Jayalal M.S
• 58 years Male Mr. X , from Puliyangudi ,
• Occupation: Bus Conductor
• Lower Socio economic class

Came with Complaints of Abdominal pain * 6 months

Vomiting * 2 months

History of Presenting illness

Patient was apparently normal 6 months back, after that he
developed abdominal pain which was insidious onset, over
epigastric region ,dull aching , not radiating, aggravated on intake
of food, releived on medications.
History of Vomiting * 2 months
4 episodes/day
2 hours after intake of food,
Contains Partially digested food Particles,
Projectile Copious
Non bilious, Non blood Stained
Vomiting releives pain.
History of Early satiety
History of Ball rolling movements
History of Melena
History of Loss of Weight ( 10 kgs in 6 months )
History of Loss of Apeptite
• No history of Jaundice
• No history of Constipation
• No history of Swelling in the abdomen
• No history of consumption of drugs

Past history
No similar illness in the past.
No previous Surgeries in the past.

Comorbid history
Not a Known Diabetic , hypertensive, Tuberculosis, Bronchial
asthma, epileptic.
Personal history
Mixed diet Consumer , Prefered Spicy Non Veg items.
Alcohol Consumer for 25 years, 1 quarter brandy/ day.
Smoker for 20 years. 6 Bidis/day. Smoking index= 120 .

Family history
No Similar illness for his family members.

Summary
58/m Smoker and Alcoholic , bus conductor by Occupation
Came with Pain abdomen and Vomiting , associated with Loss of
apeptite and Weight , early satiety,Melena, Ball rolling
movements, Probably a Case of Gastric Outlet Obstruction.
• General examination
Patient Conscious,
Oriented,
afebrile, thin built and ill nourished,
ECOG- 2, KARNOFSKY SCALE- 70%
Hydration fair
Pallor+ , No icterus, cyanosis, clubbing, pedal
edema, generalised lymphadenopathy

Vitals
Blood pressure- 110/70 mm hg in Right arm , sitting position
Pulse rate- 84/min regular rhythm, normal volume, no radio
femoral or radio radial delay.
Respiratory rate- 14/min.
Temperature- Normal.
• Examination of abdomen:
Inspection
Abdomen- Scaphoid,
Umblicus- midline
No scars/ dilated veins/ pigmentation
All quadrants moves equally with respiration,
Fullness seen over the upper abdomen
Fullness become less prominent on head raising
Visible gastric peristalsis seen
No pulsations visible, No nodules seen
Flanks appears to be free,
Hernial orifice free
External genitalia- Normal.
Left Supraclavicular fossa- Free
• Palpation
Not warm, Non Tender
Inspectory findings confirmed.
Mass of size 2*2 cm palpable over the epigastrium in vertical
and horizontal axis , irregular surface, firm in consistency,
moves with respiration, less prominent on head raising test,
Able to insuinate fingers below right costal margin
No spleenomegaly / hepatomegaly
Flanks Free
No Succusion splash
Left supraclavicular and left axillary nodes- not palpable.
Percussion
Resonant note over the abdomen
No fluid thrill , no shifting dullness
No Succussion splash
Auscultation
Bowel sounds +

Digital rectal examination

Sphincter tone- Normal
No mass / bleed
Black tary staining +
Systemic examination
Cardiovascular system - S1 S2 +
no murmurs
Respiratory system - Bilateral air entry+
Normal vesicular breath sounds
Summary
58 years old male, Smoker and alcoholic , Bus conductor by
Occupation with Complaints of Pain abdomen and Vomiting
associated with Loss of apeptite and weight , early satiety,
melena , ball rolling movements, Pallor , Epigastric mass of
size 2*2 cm , visible gastric peristalsis

A Case of Gastric Outlet Obstruction due to Carcinoma

Stomach in antropyloric region
• Thank you