Weight Loss and Early Satiety

Abstract

A 73-year-old Japanese female presents with complaints of abdominal pain, weight loss, and early satiety. She states that she has been experiencing a “gnawing” pain in the mid-epigastrium. The pain originated 8 months ago, but she attributed it to acid indigestion. She took an over-the-counter proton pump inhibitor (PPI) and some calcium carbonate (Tums), and the pain initially improved. The pain has progressively worsened, and now she is experiencing early satiety. Over the past 4 months, she has lost 25 lbs, is easily fatigued, and unable to perform daily tasks around the house. The patient has a 50 pack-year history of smoking. She denies more than the occasional alcoholic beverage. She moved to the United States 10 years ago. Family history includes her father passing away of “some type of cancer” and “ulcers” among two of her siblings. Physical exam reveals a cachectic female with tenderness to deep palpation in the mid-epigastrium, with no rebound or guarding. Laboratory findings include a hemoglobin of 8.5 g/dl (normal 12–15 g/dl) and hematocrit of 27% (36–47%) and mean corpuscular volume (MCV) of 65 μm³ (80–94 μm³). All other routine lab findings were within normal limits. A fecal occult blood test is positive.