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An 80 year old woman with intermittent severe vomiting
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  1. I S Shawa,
  2. S D Hearingb,
  3. C S J Probertb
  1. aBristol Royal Infirmary, Bristol, UK: Department of Gastroenterology, bUniversity Division of Medicine
  1. Dr Christopher S J Probert, University Division of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, UK c.s.j.probert{at}bristol.ac.uk

http://dx.doi.org/10.1136/pmj.77.907.345

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    Answers on p 354.

    An 80 year old woman presented with a two year history of vomiting, increasingly severe epigastric discomfort after eating, and 1.5 stone (10 kg) weight loss. The vomiting episodes were intermittent, with individual episodes lasting for approximately 48 hours. During these periods she was unable to tolerate food or liquid and on occasions described small amounts of “coffee ground” haematemesis. Initial investigation included a chest radiograph (fig1).

    Figure 1
    Figure 1

    Chest radiograph of patient.

    Subsequently she went on to have a further radiological investigation (fig2).

    Figure 2
    Figure 2

    Further radiological investigation.

    Questions

    (1)
    What does the chest radiograph show?
    (2)
    What investigation is shown in fig 2 and what does it demonstrate? How does this relate to the presenting complaint?
    (3)
    How else can this condition present?
    (4)
    How should this woman be managed?