Asian Institute of Gastroenterology <#a, ‘gpzyentional Radiology Reva ee Dr igus Rey De Va Sanh, Research Labs Dr Sata m3 Drv Ravan yo DrHVV Murty De J Ralot Kuna mc ee Mobeni Sth 6-3-661, Somajiguda, Hyderabad - 500 082, INDIA } Ph. 9146-23576 ons Fs 9140-25055 \ouen/ Emel igindiainto@yahoo.coin Website: vwwaigindla.net__ Sarat iia xen Medical Gastroenterology ‘DeDrnahwr eh0 878 Sau ae rnp me Bria ere Srcten amon 8 18 etc) © SUMMARY ao NAME: Mr, BIRENDRA PRASAD SINGH AGE / SEX : 76/M Sm DOA : 20.06.2023 DOD :23.06.2023 ROOM No: 214 news UHID No : 1001096115 ASIP No: 230003821 oe Pane Mobile : 9717366623 Some 2 >in 8803 a acon 0 8 DIAGNosis: Tatscoman oe + POLYPOSIS SYNDROME - (biopsy awaited) - ? COWDENS SYNDROME ate ah 2. “agen 8. Sayed Manoa. < : a2 ne HISTORY: E a ttion Mr. Birendra Prasad Singh is admitted with h/o sensation of food sticking ates throat, postprandial abdominal fullness, altered bowel habits, pain abdomen eh ot Mae since 1 year mild non localized, non radiating. H/o decreased appetite, weight ‘ urgical Gastroenterology loss (17kg) within a 8 months. seen EXAMINATION atte Saye Vitals stable. Serta oe No pallor/icterus/edema, ‘ened a 9 at tv sft P/A: Soft, non tender, BS*. No ascites. Reghuran on esha ap RS/CVS ~ Normal. Sine 8 tions c IN THE HOSPITAL 4 resthesiologyiintensive Care His routine blood investigations, CBP showed Hb-12.6, WBC-4200, platelet- Boicrtae 220.0. LFT (Tb/DB -0.6/0.2, SGOT/SGPT-18/16, ALP -191, Alb -2.3). RFT * showed urea-19, creatinine-0.66, sodium-134, potassium-4.8, INR-1.32. Viral markers (HBsAg, Anti HCV & HIV) were negative Vitamin B-12 was 1587, FBS-79, HbA1c-6.1 Whole Body PET-CT (20.06.23) showed diffuse metabolic activity along the mildly enhancing wall of entire colon with - ? Inflammatory /physiological bowel activity, no other significant metabolically active lesion noted in the rest of the scanned segment of body. UGI endoscopy (21.06.23) showed multiple sessile polyps with mucosal nodularity starting from cardia more extensive in antrum, multiple polypoidal lesions at D1 D2, whitish specks +, to rule out polyposis syndrome (COWDEN syndrome] - biopsy taken report awaited, Colonoscopy showed multiple tiny sessile polyps with mucosal nodularity +, polyposis syndrome in sigmoid, descending, transverse colon, ascending colon (COWDEN syndrome) ~ biopsy taken report awaited.Asian Institute of Gastroenterology 4.0 Comments Prothrombin tin measures the extrinsic coagulation pathway which consists of activated Factor VII (Vila), issue factor and proteins ofthe FBrnmon pay aor XV binge. | Protonged PT Administration of oral anticoagulant drugs Liver disewse. particularly obstructive jaundice 3. Vitamin K deticieney 4. Disseminated intravascular coagulation 5 Inherited deficiency of factors in extrinsic pathway (VII) and common pathway (V,X, prothrombin and fibrinogen) International Normalized Ratio Is used for defining the therapeutic ranges fr anticoagulant therapy. Appropriate therapeutic range varies swith the disease an! treatment intensity Recommended Therapeutic range for Oral Anticoagulant therapy INR 2.03 i of Venous thrombosis (High risk surgery), Prevention of systemic ‘ibrillaton, Bileaflt mechanical valve in aortic postion. Treatment of Venous thrombosis & Pulmonary embolism, Prophyl embolism in tissue hean valves, AMI, Valvular heart disease & Atri dee 1 ess should be tinicallycorelted 3 Test dane on citrated plasma Sample Type Crate Plasma * End of Report * Entered By : MRS. N. SARITHA/ - 10009301 ‘s os bAMDyhotogist : Recognised ae Centre of Excellence by World Organisation of Digestive Endoscopy BEB Sonaiguts Hyterabed ‘Hyderabad - 500 062, INDIA. Ph: 81-40-2337 8888 (10 lines), Fax : 91-40-2332 4255, Emal: akgndlainfo@vahoo co In PathologistPatient Name MR. BIRENDRA PRASAD SINGH Age / Genaer 76 Years / Male Patient iD Ret. Consutant AGS DOCTOR Ma OeSTHe Bill No ASWR230086475 Bilt Date 20.06.2028 1320 Patent Type IP Sample 10 s230181279 Ward/Bed | 2ND-AC/ /214 {PCASENO ‘s1P290009821 Current Bed 214 i Receiving Date & — 20-06.2028 1442 Reporting Doty 20.06.2023 16:22 Asian Institute of Time ime Gastroenterology See HORMONE REPORTS Investigation Result Unit Biological Ref. Range Vitamin B12 VaR oo 4 1587 pgimi 197-771 iefceney may be due to lack of IF secretion by gastric mucosa (eg, gastrectomy, gastric trophy) or intestinal malabsorption (eg, smal testinal diseases). Vitamin B12 deficiency frequently causes macrocytic anemia, gloss, peripheral neuropathy, weakness hyperelena.atana, loss of proprioception, poor coordination, and affective behavioral changes, many patients have the neurologle sefests wihout macroeytie anemia, Pemicious anemia fs a macrocytic anemia caused by vitamin B12 deficiency that is due to a lack of IF seeretion Dy gastne mucosa. levels less than 180 ng/L. are considered evidence of vitemin 812 deficiency. Follow-up witha test for antibodies to intrinsic factor ' ;ecommendes to enti this potential cause of vitamin B12 malabsorption. For specimens without antibodies and the patent is nave Solow p est fr wamin B12 tissue dfiency my be ndated, Consider anayis of methyimelonc acd (MMAS ) ardor homocystene HCYSP) ‘a9 creased serum methyimalonic acid (MMAS) levels more specic for calllar-Jevel B12 deficiency and isnot increased by folate ‘ations beng evaluated for vitamin B12 deficiency wi have Itrinsic factor blocking antibodies (IFBA), fase elevations of vitamin 2 cue to IFBA interference, potentially obscuring a physiological deficiency of vitamin B12, If observed vitamin B12 concentatons "wh clinical presentation, measurement of meltymalonic acd (MMAS) should be considered Pauents with Serum vitamin B12 levels between 150 and 400 ng/L are considered bordetine deficient and should be evaluated futher by 2 esis for vitamin B12 deficiency, Plasma homocysteine measurement (HCYS) is a good screening test where a normal level effectvely ‘uses vta7in B12 and folate deficiency in an asymptomatic patient. However, the test ‘not specie, and many situations can cause an ‘THYROID PROFILE (T3, T4, TSH) 08 ngimt. 08-20 4 cae 78 gia 48-120 TSH cau 0.40 lum 027-42 Interpretations: 1. TSH levels are subject to circadian variation, reaching peak levels between 2 - 4.a.m. and at a minimum between 6-10 pm . The variation is of the order of 50%, hence time of the day has influence on the measured serum TSH concentrations, *\ commended test for T3 and 74 is unbound fraction or free levels as metabolically active. 5. Physiological rise in Total T3 / T4 levels is seen in pregnancy and in patients on steroid therapy. Clinical Use - Primary Hypothyroidism ,Hyperthyroidism Hypothalamic - Pituitary hypothyroidism, Inappropriate TSH secretion Nonthyroidal illness , Autoimmune thyroid disease , Pregnancy associated thyroid disorders ,Thyroid dysfunction in infancy and early childhood Sample Type Serum “* End of Report ** \ Entered By : MS. VANAJA K / Dr. G. Deepika 0701313, MD Biochemistry Sr.Consultant & HOD Bi hemi Print Date 20-06-2023 17:44 Recognised as Cente of Excellence by World Organisation of Digestive Endoscopy 63.583, Semeliguda, Hyderabad - 500082 INDIA. Ph 81-40-2357 6866 (10 Ines), Fax: 6140-2352 4255, Ema axndainfo@vehooacieLABORATORY REPORT Pationt Name MR. BIRENDRA PRASAD SINGH hacrcente ——76vens IM Patetio tl Ret, Consuitant IGS DOCTOR Bill No. ASWR230066475 1001096115 | i bate 20-06-2028 1320 Patient Type Sample 10 ‘8200161275 Word/Bed | 2ND-AC/ 1214 IPCASENO -SIP230003821 CurrentBed 214 Reconing Date & 700520001642 Reporting Date 2006-208 728 Asian Institute of Gastroenterology 7 iat SEROLOGY REPORT Investigation Result Biological Ref. Range ANTIHGV (GLIA) | antiney Non Reactive SICo>10 Reactive tN iitkcco ouamumescence (un) $10 05-0.99 Berderine SiCo<09 Non Reactive satan 9 sreenng os whic detects antibodies te HepasC wns. The resus tam tise shoul be uted and inlerpete ely the conte of he overal cic Qos oon oactve result recent exposure in person tested suspected, est or HCV RNA jescive resus consstent wth cument HCV infecton or past HCV infecton that has rescue, cr ‘ake posily for HCV antiody. Testing for HCV RNA ie avrnendea 9 Seni eet fecbon ‘cous ae Seen m Autoimmune diseases, Hyperammaglobulnenia,Paroteineni end passive antbody ante, Hiv spoT Negative IBsAg SPOT Negative Mepos Sorocronaicgaahy 1BsAg - Negative SIC0>1.0 Poste onss Duct CHeMRLNMNESCENCE cL) 'SIC009-099 Borderline SICo<0.9 Negative Hv Non Reactive SiCo>1.0 Reactive sone cate UMINESCENCE eum) SIC009-099 Borderine SiCo<09 Non Reactive Sample Type Serum The test marked with an * is not accredited by NABL ** End of Report ** a - we Entered By : MS. G AMBIKA /701365 Dr. B. Uma Maheshwari CONSULTANT MICROBIOLOGIST Print Date 20-08-2028 17 45, GA \om@/ Recognised as Centre of Excelence by World Organisation of Digestive Endoscopy Ete 561, Somajguda, Hyderabad - $00 082, INDIA Ph 91-40-2357 88 (10 nes) Fax: 01-40-2392 4255, Ema: aandiaifotbvanoo coinPatient Name _~IR.BIRENDRA PRASAD SINGH Ili mn Age Gender 78 Years / Male Patient 10 cae aawmanomars Tooros6 tt ein Date 20-06-2023 13:20, Patient Type IP Sample 10 8230161277 Ward / Bed /2ND-AC/ /214 rece oa Hooves wonsive stan Institute of Time & Time Gastroenterology pene BIOCHEMISTRY REPORT lnvestigation Result Unit Biological Ref. Range TOTAL BILIRUBIN oro 08 maid 03-12 DIRECT BILIRUBIN orc 02 maid <02 NDIRECT BILIRUBIN casunne o« mals SGPT (ALT) eche wna ose 16 un Mate :<50 SGOT (AST) ec herwoo 18 un Mate : «50 Aiur asmaeiir 4 191 un se-119 1 ALPROTEINS ave. 7 ama. 66-83 ALBUMIN(SERUM) aca . (23) oa 3246 SLOBULIN cats 2 ‘mid 23-35 possible drug coxiny. Sample Type. Serum Entered By : MS. VANAJA K / 0701313 ») Print Date’ 20-06-2023 17:42 “* End of Report * 3. Deepika MD Biochemistry ‘Sr.Consultant & HOD Biochemistry Recognised as Centre of Excellence by World Organisation of Digestive Endoscopy of 6851, Somajiguda, Hyderabad - 500 082 INDIA. Ph: 91-40-2337 8898 (10 ines), Fax: 91-40-2582 4255, Ema lanclamiodvancB Sdlent Name MR. BIRENDRA PRASAD SINGH ‘9° Gender 76 Years / Male Pationt ID @f. Consultant AIGS DOCTOR = samasooseays 1001096115 i Date 20062023 1320 ‘Pationt Type iP ample iD -ASZ30161279 Ward/Bed —/2ND-AC/ /214 SCARENO -ASIP220008621 Current Bed 214 . : ‘eceiving Date & 20-06-2023 14:42 Reporting Date 23.06.2023 09:63 Asian Institute of ime 8 Time Gastroenterology HORMONE REPORTS vestigation Result Unit Biological Ref. Range MITAMIN D ( 25-HYDROXY VIT-D ) Vitamin D cua 332 mL. 30-100 Deficiency: Below 10 ng/ml insufficiency : 10 30 ng/ml Sufficiency: 30 - 100 ng/ml Toxicity: Above 100 ng/mi Interpretations: 25 OH vitamin Dis total of vitamin D in bone and mineral metabolism was recognized from it fist identification ‘53 factor that could cure rickets. However, vitamin Dis now recognized as a prohormone which has multiple roles in Pe@¥aining optimal health. vitamin D toxicity is 2 recognized problem but a rare occurrence. instead, a recent growing public health problem is vitamin D insufficiency. ‘Sample Type: Serum ** End of Report ** * The test marked with an * is not accredited by NABL wert Entered By : Mrs. MAMATHA/ DR.G. DEEPIKA Dr. Vidyavathi Devi G 701086 MD Biochemistry MD Biochemistry ‘Sr-Consultant & HOD Biochemistry \Ur-Consultant Biochemistry Print Date: 23-06-2023 13:23, Recognised as Conte of Excolerc by Word Organsaon of Digestive Endoscopy S461, Somajiguda, Hydrabd - 500082, NDIA Ph 64025578556 (10ines), Fx: 01-40-2332 4255, Ema agnaanio@vank SRT ATPatient Name MR. BIRENDRA PRASAD SINGH figiosae——|}voon ime Patetio | Ref. Consultant. AIG DOCTOR Bil No. ‘RSWR230087123 1001098176, Bil Date 7-08-2023 2247 i Patient Type IP ‘Sample 10 |AS730152447 Ward/ Bed /2ND-AC/ i214 IPCASENO AASIP230003821 Current Bod 214 i 4 Receiving Date & 21-06-2023 23:04 Reporting Osteo” |22.06-2029 08:48 Asian Institute of Time &Time Gastroenterology BIOCHEMISTRY REPORT Investigation Result Unit Biological Ref. Range RBS (RANDOM BLOOD SUGAR) RANDOM BLOOD GLUCOSE iecunnse 82 mg/dl 74-140 Interpretations: Random plasma glucose >200 mg/dL on two or more occasions, along with typical symptoms is diagnostic for diabetes rmelitus. Patients with impaired glucose tolerance (IGT) are those whose plasma or serum glucose is above the reference range but less than 200 mg/d uring 2 hour OGTT with fasting plasma glucose values less than the diabetic range. These patients have increased risk of developing type 2 diabetes and should be followed up with repeated testing. Hypoglycemia, @ decrease in blood glucose to levels to below normal, may be caused by excess administration of insulin, overtreatment with © _ypogtycemic drugs, some toxins such as alcohol and hyposlcins, severe hepatic dysfunction, Insulinamas, insulin antibodies, non- Be@jestic neoplasms, septicaemi, chronic renal fallure and reactive hypoglycaemia ‘Cautions: In the absence of unequivocal hyperglycemia, the diagnosis of diabetes mellitus should be made by repeat testing ‘Sample Type: Sodium Fluoride “End of Report ** Entored By : Mrs. MAMATHA/ Br. G. Deopika 701086 MD Biochemistry Sr.Consultant & HOD Biochemistry Print Date: 23-06-2023 13:05 Kn TO omen / ~ Recognised as Cont of Excelence by Wo Organisation of Digestive Endoscopy of (6-3-661, Somajiguda, Hyderabad - 500 082, INDIA. Ph : 91-40-2337 8886 (10 lines), Fax : 91-40-2332 4255, Emeit aighdiainfo@yandoi@FitHOSPITALS SAls Patient Name: Mr. BIRENDRA PRASAD SINGH Age/Gender:76 Years / Male UHID: 1001096115 Date: 22/06/2023 | g Doctor: AIG DOCTOR Whole Body PET-CT Sean Clinical Diagnosis: . H/o weight loss, multiple polyps in colon. PET-CT for evaluation, Technique: Whole body PET images were acquired from vertex to mid-thigh using a dedicated PET-CT scanner ~60 minutes after intravenous administration of ~8.6 mCi of I8F- FDG. Reported fasting blood sugar level at the time of administration was within acceptable © _ limits (85 mg/dl). Data was reconstructed with CT based attenuation correction in to axial, sagittal and coronal PET sections and interpreted after fusion with contrast enhanced CT images. FDG uptake is semi quantitatively assessed as SUV max. ~ Age related cerebral atrophic changes noted. ~ Rest of the brain parenchyma appears normal in attenuation. ~ No supra /infratentorial focal / diffuse lesion is noted ~ Physiological FDG uptake is noted in the entire brain parenchyma. NECK: ~The upper aero-digestive tract and PNS appears normal. ~ Thyroid appears normal with physiological FDG uptake. ~ No significant metabolically active cervical / supraclavicular lymphadenopathy is noted. CHEST: ~ Low grade FDG uptake seen in subcentimeter sized few pretracheal, precarinal, AP window, bilateral hilar lymph nodes, largest measuring ~8mm (SUV max:3.8) in precarinal node - ? Reactive ~ Bilateral lung parenchyma appears normal in attenuation, ~ Heart and the great vessels appear normal. ~ No other significant metabolically active mediastinal / axillary lymphadenopathy is noted. ~ No pleural or pericardial effusions seen, @Windspace Road, Gachibowl Hyderabad, Telangana -500032 @ 491 40.4244 4222 @ infoeaighospitalscom @ wiwwaighosptascom AIG Hospitals (aunt of Asian institute of Gastroenterology) CIN: U99999TG1994PTC018352HOSPITALS | Patient Name: Mr. BIRENDRA PRASAD SINGH _Age/Gender:76 Vears Male] UHID: 1001096115 Date: 22/06/2023 Referring Doctor: AIG DOCTOR ABDOMEN AND PELVIS: ~ Moderate to high grade diffuse heterogeneous increased FDG uptake seen along the mildly enhancing wall of entire colon with no focal abnormal FDG uptake (SUV max 11). ~ _Non-FDG avid tiny hypodense lesion noted in segment IV of liver, measuring ~ 2 mm ~ ? Benign. Rest of the liver shows physiological FDG uptake. Non-FDG avid tiny hypodense lesion noted in spleen, measuring ~ 5 mm - ? Benign. Rest of the spleen show physiological FDG uptake. ~ Pancreas, bilateral kidneys and adrenals appear normal in attenuation with physiological FDG uptake, ~ Rest of the visceral structures appear normal in attenuation with physiological FDG uptake. No ascites. ~ No other significant metabolically active abdominopelvic lymphadenopathy noted BONES: ~ Degenerative changes noted in spine. ~ Rest of the visualized bones appear normal in attenuation and alignment. ~ Normal marrow density is noted with no focal lesion and physiological FDG uptake. @ Normal physiological '*F-FDG tracer uptake is seen in rest of the visualized organs. (© Mindspace Road, Gachibowl, Hyderabad Telangana -500032 @ 491 4042444222 @ infoaaighospitalscom @ wwwaighosptalscom ‘AIG Hospitals (a unit of Asian Institute of Gastroenterology) CIN: U99998T61994PTC018352AIG HOSPITALS UHID: 1001096115 | Referring Doctor: AIG DOCTOR IMPRESSION: Ina given clinical scenario, the activity along the mildly enhan physiological bowel activity. ly correlate. DR. MOFIAMMED SALEEL K MBBS; DNB Nuclear Medicine Nuclear Medicine and PET No other significant metabolicall body. Patient Name: Mr. BIRENDRA PRASAD SINGH Age/Gender:76 Years 7 Male | Date: 22/06/2023 | - | Present PET-CT scan findings reveal diffuse metabolic cing wall of entire colon with as described -? Inflammatory/ Suggested colonoscopic biopsy correlation. ly active lesion noted in the rest of the scanned segment of ots DR. B. SUNEETHA MBBS; MD (SGPGIMS, Lucknow) Fellowship in Nuclear Oncology HOD and Sr. Consultant Nuclear Medicine and PET (Please carry report and CD on your next visit for comparison) {in case of any discrepancy due to typing oF machine ror, please gt it rected immediately) Mindspace Road, Gachibowl, Hyderabad, Telangana -500032 @ +91 4042444222 @ infogaighospitalscom @ wwwaighosptalscom AIG Hospitals (a unit of Asian Institute of Gastroenterology) CIN: U9999STG1994PTC018352UPPER GI ENDOSCOPY REPORT Patient Information Patent Name" MR BIRENORAPRASAD Bl No « aswrazoseo4s Sn ge Gander: 76¥%85 Mth ai pote 1.06200 144329 UMD: s0ot08t1g ReporingNo = ASSRG22352 Asian neti fatty -NDoCTOR Repeingbne : aropatasiszisn Sian Institute of UG! ENDOSCOPY oy Clinical Diagnosis = Medcaton rows esophagus NORMAL, e MULTIPLE SESSILE POLYPS WITH MUCOSAL ‘Stomach NODULARITY STARTING FROM CARDIA MORE EXTENSIVE IN ANTRUM Duodenum Cap MULTIPLE POLYPOIDAL LESIONS AT D1D2 2nd Part WHITISH SPECKS+ Biopsy : Taken IMPRESSION ‘TO RIO POLYPOSIS SYNDROME ( COWDEN SYNDROME ) f eA) Kai \ono/ a Or 0 ageewar Rey Or. arth Pal Chet customers Record Cnt xno by Wad Cnn Digs nxn 63-661, Somajiguda, Hyderabad - 500 082, INDIA. Ph: 81-40-2337 8888 (10 lines), Fax: 91-40-2832 4265, Emait igindlainfo@yahoo.co.n