Virginia Research Day 2022

Medical Resident Research Case Reports

04 Intractable, Recurrent Episodes Of Abdominal Pain, Nausea And Weight Loss Secondary To Rare GI Tumor (GIST)

Salma Khan, DO; Amber Stephens, DO Corresponding author: Salma.Khan@LPNT.net

SOVAH Health Family Medicine Residency

Context: Intractable recurrent abdominal pain, nausea, and weight loss secondary to rare GI tumor (GIST). Case report: A 70-year-old African American male presented for intractable abdominal pain with associated nausea and weight loss of 30 lb. He was admitted a few months ago secondary to significant DKA. Since then, has lost significant amount of weight. Patient has difficulty with nausea and significant abdominal pain and feeling full. Primary care physician has recently started him on iron due to anemia. He was referred to gastroenterology and a CT scan of the abdomen demonstrated a large abdominal mass originating from the stomach. Patient was set up for EGD and colonoscopy as an outpatient, however, his pain worsened significantly with the accompanying nausea and vomiting. Underwent a repeat CT scan which again demonstrated a large abdominal mass with numerous liver lesions. Past Medical History: HTN, HLD, DM Type 2, CAD s/p PCI 2005, DVT. Family History: Brother has colon cancer

Social History: Denies smoking, alcohol, or illicit drug use. Pertinent ROS: Weight loss, early satiety, left lower abdominal pain. Pertinent PE: Tenderness to palpation on left middle and left lower quadrant of abdomen with mild distension. Large palpable firm mask on left abdomen. Hyperactive bowel sounds. Vital signs: BP 121/66, HR 80, RR 22, Temp 98.7, Pulse ox 98 %RA. Pertinent diagnostic studies: Hemoglobin 8.4, CT abd/pelv with IV contrast multiseptated mass along the greater curvature of the stomach with areas of irregular soft tissue thickening. Multiple lesions throughout the liver. Fine needle liver biopsy showed GIST. Diagnosis: Large symptomatic metastatic GIST tumor. Treatment: Patient is presented in tumor board and discussion was held about palliative debulking of tumor was recommended. Patient

underwent exploratory laparotomy, partial gastrectomy with en bloc resection of tumor and distal pancreatectomy with splenectomy. Patient was referred to hematology-oncology along with radiation oncology. Patient received Hib, meningococcus, and influenza vaccine. Advised to get Pneumovax at PCPs office. Comment: Four types of standard treatments are used after diagnosis of GIST. Surgery, Targeted therapy, watchful waiting, and supportive care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) are the drugs that block signals needed for tumor to grow. If a GIST gets worse during treatment or side effects occur, supportive care plays a role. Radiation therapy is sometimes given to relieve pain in patients with large tumors.

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