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Answers on p 517.
A 40 year old housewife was referred with a nine month history of intermittent watery diarrhoea and intermittent abdominal pain. The diarrhoea occurred four to five times a day and there was no blood or mucus in the stools. Her only past medical history consisted of heartburn which was treated with ranitidine 150 mg twice a day by her general practitioner. She did not smoke and only drank occasionally. Physical examination revealed a 5 cm enlarged non-tender liver. Stool cultures revealed no growth. She underwent upper gastrointestinal endoscopy which revealed grade II oesophagitis and diffuse duodenitis and a small bowel series showed fine ileal ulceration. Colonoscopy was normal. Computed tomography of the abdomen showed multiple lesions throughout the right and the left liver highly suspicious of metastatic disease.
- What is the diagnosis?
- How would you confirm this?
- What are the treatment options?