Introducing GIST and Dieulafoy - Think of Them in GI Bleeding and Anemia.

Common presentations of gastrointestinal bleeding include hematemesis, melena, and history of dizziness, fatigue, or syncope; yet, bleeds may present in many uncommon ways. This review discusses two cases of gastrointestinal bleeds (GIBs) in middle-aged female patients who presented with anemia and recurrent unexplained GIBs. Both patients were misdiagnosed for several years before the cause of their bleeding was established. Dieulafoy lesion is said to be rare, although its precise incidence is difficult to establish due to its anatomically inaccessible location, small size, and lack of symptoms prior to presentation. This condition can result in gastrointestinal hemorrhage and quickly pose life-threatening complications. Gastrointestinal stromal tumors (GISTs) are likewise difficult to diagnose due to their location in the submucosa and lack of good diagnostic tools. Depending on tumor size, location, and spread, GISTs can have a poor prognosis even with early intervention. By presenting the two cases, this review aims to bring attention to Dieulafoy lesion and GIST as arguably not-so-rare but potentially fatal sources of GIBs. Especially troublesome is the uncommon complication of GIST to perforate and the elusive nature of Dieulafoy lesions that require diligent evaluation. For these reasons, both should be considered in the differential diagnosis in patients with recurrent unexplained GIBs and anemia.

Elevated Vitamin B12: A Rare Presentation for Gallbladder Adenocarcinoma.

Gallbladder cancer (GBC) is relatively rare and usually has vague clinical presentation. Vitamin B12 (Cobalamin [Cbl]) deficiency is well recognized clinical entity, in contrast, elevated Cbl remains largely unknown and underestimated in practice. We report an elderly patient who presented with generalized weakness. She found to have elevated serum Cbl which raise the suspicion for malignancy. Subsequent imaging studies and tissue biopsy led to diagnose gallbladder adenocarcinoma. Elevated Cbl has been associated with increased risk of subsequent diagnosis of cancer. In addition, elevated Cbl levels in cancer patients have a strong predictive value for mortality, frequent metastases, and poor prognosis. In this case, the incidental finding of high Cbl level led to the diagnosis of serious illness which could otherwise present in a more advanced stage.

Burning Tongue as Initial Presentation of Celiac Disease in an Elderly Woman: A Case Report.

There are few reports in the literature where celiac disease presents with tongue manifestations, although atypical presentations of celiac disease are not uncommon. This case report highlights an atypical presentation of celiac disease in an elderly female. Our patient presented to clinic with complaints of a burning tongue for the past two years as well as occasional loose stools and fatigue. Work-up revealed iron deficiency anemia, zinc deficiency and an abnormal celiac panel. Complete symptom improvement was noted by 10 weeks into the initiation of a gluten free diet. Celiac disease can present at any age and should be considered as a differential in findings of malabsorption and gastrointestinal symptoms.

Osteoporosis: A Review.

Osteoporosis is a silent disease which can significantly increase an individual's risk of fracture. Fractures can be physically debilitating and consequently cause a financial burden on the patient, so it is key to treat osteoporosis before a fracture occurs. Osteoporosis is defined based on the patient's bone mineral density (BMD) as compared to a young adult's BMD using standard deviations (SD). Normal BMD is within 1 SD of young adult mean, osteopenia is between 1 and 2.5 SD less, and osteoporosis is greater than 2.5 SD less than the mean. Severe osteoporosis is defined similar to osteoporosis but includes the presence of fragility fractures.

Asymptomatic cervical stiffness as the sole presenting feature of ovarian follicular lymphoma: The value of hands-on medicine.

A primary care visit is the first encounter of a patient with health care. In context to malignancies, breast cancer and primary ovarian lymphomas are NA clinically and morphologically different malignancies. The rare concurrence of breast cancer and non-Hodgkin lymphoma (NHL) does not warrant any routine surveillance through testing but we present a case of a 71-year-old female with the history of invasive ductal carcinoma of the breast in remission who was diagnosed with follicular carcinoma after an abnormal pelvic examination during her routine primary care visit. This highlights that a routine PC visit with a skilled physical examination can prove to be one of the most cost-effective tools for screening high-risk cancer patients in remission.