Immune System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This elderly man has presented with intermittent upper abdominal pain for 3 weeks, in association with anorexia, nausea, and vomiting; examination reveals mild epigastric tenderness.\n\nGastric malignancy is a very real concern here, given his age and history of dyspeptic symptoms; peptic ulcer disease, acute cholecystitis, and acute pancreatitis are other important considerations.\n\nLast but not least, the possibility of mesenteric ischemia should be kept in mind, as this is a potentially lethal condition which is surprisingly easy to overlook.\n\nHis workup should start off with a complete blood count (CBC), liver profile, pancreatic enzyme assay, and ultrasound scan of the abdomen.\n\nThe CBC is only significant for mild anemia and a neutrophil leukocytosis, both of which are nonspecific findings. In addition, pancreatic enzymes are within normal parameters, while the liver profile reveals only hypoproteinemia and hypoalbuminemia.\n\nHowever, his ultrasound scan reveals a rather peculiar fin"}]}

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