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- W2977804734 abstract "Purpose: A 21-year-old man with no past medical history was admitted to the medical intensive care unit with hypotension and hypoxia. The patient denied any gastrointestinal bleeding or abdominal pain. Family history was unremarkable for colon or liver disease. He was eventually felt to have sepsis and acute respiratory distress syndrome. Lab data revealed a hemoglobin of 8.5, with a mean corpuscular volume of 65 and ferritin of 16. His liver function tests (LFTs) were mildly elevated on admission; however, on hospital day four, his aspartate aminotransferase rose to 374, alanine aminotransferase rose to 228, and alkaline phosphatase rose to 311. The patient had received ethacrynic acid earlier in his hospital course, and the elevated LFTs were attributed to this medication as well as sepsis. Ethacrynic acid was stopped, and the LFTs improved. As part of the workup for the elevated LFTs, a liver ultrasound was performed, which revealed a right hepatic mass measuring 7.3 cm. Magnetic resonance imaging demonstrated a 6-cm subcapsular mass in the right hepatic lobe with at least two satellite nodules. Biopsy of the mass revealed moderately differentiated adenocarcinoma, intestinal type. Given this cancer and the patient's anemia, colonoscopy was performed, which revealed a partially obstructing tumor in the proximal rectum (Figure 1), as well as innumerable polyps ranging from three to 20 mm throughout the colon (Figure 2). The endoscopic findings were concerning for familial adenomatous polyposis (FAP). Pathology from the rectal mass revealed invasive, moderately differentiated adenocarcinoma. Pathology from the larger polyps revealed tubulovillous adenomas, while biopsies of several of the smaller polyps revealed tubular adenomas. An esophagogastroduodenoscopy was performed, demonstrating multiple gastric polyps. Pathology was notable for fundic gland polyps. The patient was started on a chemotherapeutic regimen composed of folinic acid, fluorouracil, and oxaliplatin (FOLFOX), underwent preoperative radiation therapy, and eventual total proctocolectomy with loop ileostomy and liver resection, and continues his chemotherapy with the plan to complete a total of 12 cycles. This case demonstrates several important teaching points. First, in a young male patient who presents with severe iron-deficiency anemia, even in the absence of gastrointestinal symptoms, a thorough investigation of the gastrointestinal tract is necessary. Second, the absence of a positive family history does not rule out the possibility of FAP. Finally, a simple non-invasive test, such as an ultrasound, should be considered in all patients who present with elevated LFTs." @default.
- W2977804734 created "2019-10-10" @default.
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- W2977804734 date "2013-10-01" @default.
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- W2977804734 title "The Tip of the Iceberg: A Work-up of Transaminitis Reveals Metastatic Rectal Cancer in the Setting of Familial Adenomatous Polyposis" @default.
- W2977804734 doi "https://doi.org/10.14309/00000434-201310001-01352" @default.
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