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Difficult to Identify

difficult-to-identifyVague symptoms belied a 59-year-old woman’s dire situation. She presented with a 3-month history of abdominal pain, constipation, and anorexia, accompanied by a 40-pound (18.1 kg) weight loss. Initially she had attempted to manage her symptoms conservatively, but worsening abdominal pain, bloating, and loss of appetite prompted her to seek medical care. The patient denied fevers, chills, nausea, vomiting, or blood in her stools. Ten years earlier she had undergone total hysterectomy with bilateral oophorectomy for significant endometriosis. Her medical history also included hypertension and migraines. She was a veteran and retired journalist who lived alone, had never smoked, and had not used alcohol or illicit drugs to any significant extent.

On examination, the patient appeared fatigued but was alert and conversant. She was afebrile with blood pressure of 132/78 mm Hg, a heart rate of 107 beats per minute, a respiratory rate of 16 breaths per minute, and an oxygen saturation of 98% on room air. Her mucous membranes were dry, and a cardiac examination revealed regular-rhythm tachycardia without murmurs, rubs, or gallops. Her abdomen was soft with normal bowel sounds, mild tenderness to palpation in the epigastria and right upper quadrant, and a noticeable mass in the right middle quadrant.

Initial laboratory results were consistent with dehydration but otherwise unremarkable.

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– Beth S. Zha, MD, PhD, Margaret Flanagan, MD, Caley Coulson, MD, Kanishka W. Garvin, MD

This article originally appeared in the November 2015 issue of The American Journal of Medicine.

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