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Weight Loss 
St George’s hospital
Michael Foray - Second foundation year
Chiara Goodwin - GI consultant Chiara Goodwin
Jonathan Gary
28
Single – lives with brother
- Weight loss (12-> 8 stones: 23 kilos over 10 weeks)
- Bloody diarrhoea
- Fatigue
- Constant right upper-quadrant abdominal pain – gradual onset – medium intensity (5/10)
- Fever of 38°C
- Went to India 7 months prior to presentation – returned to England two weeks before onset of symptoms.
- Healthy brother, aunt had cancer.
- 53 kilos for 182 cm – BMI of 16
- Pale
- Diffuse abdominal tenderness, liver 8cm below the costal margin and slightly painful on palpation
- No ascites or oedema
- Electrolytes (sodium chloride, potassium, Blood Urea Nitrogen and creatinine) at baseline
- Hemoglobin10.5
- White blood count 12.6
- ESR 50
- hepatitis markers negative: ALT 35, AST 60
- HCV and HAV markers negative
- Bilirubin 14
- Stool sample: 40 white blood count, 1-2 RBC/view, negative for bacteria
- Infection while travelling: probably non-hemorrhagic pathogens: not e-coli or salmonellosis
- Pyogenic hepatic abscesses
- Chron’s disease
- Ulcerative colitis
- GI cancer
- CT scan
- Ultrasound of the liver
- Colonoscopy with biopsy
- Blood culture + stool culture
- Differential blood count
- Colonoscopy: ulcer in the rectum, contact bleeding and oedema of the mucous membranes. No inflammatory lesions
- Ultrasound: 14cm cavity with fluid in the left lobe of the liver – confirmed by the ct scan
- No evidence of a tumour
- White blood cell count differential: baseline
Amoebiasis
Metronidazole in combination with chloroquine as well as doxycycline + surgical drainage of the abscess
Progressive improvement expected