What Causes Diarrhoea And Abdominal Pain Along With Loss Of Appetite?

Dear doctors, My name is Asma Omer, I m medical doctor that practice in Sudan. attached is medical report regarding my uncle who lives in Sudan, I really appreciated if you could review it and give me your opinions. Thank you Asma omer My e mail YYYY@YYYY Case Summary Reference: Abdellatif Omer Hassaballa 21/02/2015 Mr. Abdellatif Omer is an 80 years old Sudanese citizen who lives in Khartoum, Sudan. He is known to be hypertensive and diabetic. In July 2014, Mr. Abdellatif started to complain of diarrhea , loss of appetite and abdominal pain. He described this diarrhea as loose frequent stool, unusual for his bowel habit, while his pain was mostly vague lower abdominal aches. From that time, Mr. Abdellatif started to lose weight gradually. In August and September 2014, He was seen by a senior gastroenterologist in a private hospital in Khartoum, where thorough clinical evaluation and medical investigations were carried out, including CT abdomen with contrast, MRCP, ultrasonography and blood tests. The major findings were a dilatation in the common bile duct, a dilatation in the pancreatic duct and diverticulosis noted in the descending colon. No masses or signs of inflammation were found at that time. In October 2014, Mr. Abdellatif went to Dubai, UAE for medical treatment. More investigations were done there including colonoscopy, gastroscopy and echocardiography. The endoscopies revealed diverticulosis and two small polyps in the caecum and descending colon, measuring 2.5 and 0.5 centimeters in diameter respectively. The smaller polyp was removed and a biopsy from the bigger one was taken. Both specimens were investigated and revealed no abnormality. These findings were excluded as a possible cause for the patient’s complaint. The echocardiograph showed severe pulmonary hypertension along with moderate aortic regurgitation. A GIT biochemical profile showed marked elevation in pancreatic enzymes. Tumor markers (CA 19-9 & CEA) were within normal ranges. After having all this information at hand, the physicians taking care of the patient’s case concluded that this condition was probably a chronic moderate -age related- type of mal-absorption, which they suggested would better be managed by dietary control only. Since coming back to Sudan in January 2015, Mr. Abdellatif has not been showing any improvement in his condition. On the contrary, he continues to have diarrhea and abdominal pain, has lost more weight, and is unable to perform his routine daily activities. He later developed ascites and lower limp edema. Later in last January, Mr. Abdellatif was admitted to a private hospital in Khartoum where a new round of investigations were carried out. This time the radiological scans (MRCP and ultrasound) showed a new finding in the form of a small mass (1.5cm) located at the head of the pancreas , in addition to a wider dilatation of both pancreatic (0.6 cm) and common bile (0.9 cm) ducts compared to the previous scan (done in August 2014). The tumor marker (CA 19-9) was significantly elevated this time (132 u/ml, reference range 0-37 u/ml). The ascetic fluid was investigated for malignancy and acid-fast bacilli (for abdominal TB), but revealed no abnormal findings. A fine needle biopsy (FNB) from the pancreatic mass was attempted, and although it was not conclusive, suspicion of malignancy was noted in the form of few clusters of pleomorphic cells with hyper-chromatic nuclei. A new CT abdomen has been requested but not done yet. Mr. Abdellatif is currently on Amlodipine 5 mg OD, combizym (protease, amylase & lipase) with meals, plus antidiarrheal medications as needed. There is a need for further investigations to reach at a definitive diagnosis and establish a clear plan of management.