Personal and Social History

• A delivery man
• Smoker: 38 pack years
• Alcoholic drinker: 10 beers per day since 15 years old until 1990
• No food preference
Review of systems

Constitutional: (+) Body weakness, (+) weight loss, (+) anorexia

CNS: (+) headache, (-) dizziness, (-) blurring of vision
CVS: (-) chest pain, (-) orthopnea, (-) palpitations
Respiratory: (-) cough and colds, (-) difficulty of breathing
GIT: (+) abdominal pain, (+) vomiting, (-) diarrhea, (-) constipation
GUT: (-) urgency, (-) frequency, (-) dysuria, (-) polyuria
NMS: (+) body weakness, (-) joint pains, (-) numbness
Physical Exam

• General Survey: Patient is conscious, coherent, afebrile, ambulatory, not in cardiorespiratory distress, with the
following vital signs:
BP: 130/80 mmHg CR: 79/min RR: 22/min T: 36.5 °C
• HEENT: Pale palpebral conjunctivae, icteric sclerae, no nasoaural discharge, no tonsillopharyngeal congestion
• Neck: supple, flat neck veins (at 45°), no lymphadenopathy
• Chest and lungs: symmetrical, no retractions, no lagging, resonant on percussion, with fine bibasal crackles, no
wheezes
• Heart: adynamic precordium, apex beat at 5 ICSMCL, normal rate and rhythm, no murmur
• Abdomen: slightly globular, normoactive bowel sounds, soft, with slight right upper quadrant, liver span of 14 cm,
obliterated traubs space, negative costovertebral angle tenderness
• Rectal examination: no skin tags, no fissures, good sphincteric tone, empty rectal vault, no pararectal tenderness, no
masses, no blood nor feces on withdrawal of examining finger
• Extremitiies: no palmar erythema, no asterixis, no gross deformitites
• Skin: with hyperpigmented patch on the shin of both lower extremities
Neurologic Examinaton: unremarkable
Temporal Profile

Icterisia

Body weakness

Abdominal Vomiting
Anorexia enlargement
Headache
Weight Loss
Abdominal pain

Yellowish
watery stools

7 weeks PTA 6 weeks PTA 2 weeks PTA 3 days PTA 3 hours PTA Admission