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Original Question

57 years old Caucasian male present with generalized abdominal pain and fullness, urinary uregency, frequency and nocturia for 2 months. Reports having unintential weight loss of 40 lbs over the last 6 monthsand he has been experiencing fatigue, malaise, general body aches, polydipsia, Polyuria. He hasnot seen physician since he was a child. No past medical and surgical studies. Social history: Quit smoking 5 years ago but smoked 4 pack a day for 8 years. Denies ETOH and drug use. Family History: Mother: has some type of cancer but doesnot know what kind. Parkinson’s disease, pneumonia Father: Diabetes, CKD, HTN Physical exam: Vitals: 98.6-82-18-160/90, 98% on RA Alert and oriented x4. Obese. No acute distress. Head: Normocephalic and atraumatic Eyes: Puplis equal, round and recative to light. No Nystagmus. No scleral icterus Neck: Neck supple. No JVD present. No tracheal deviation presentNo Thyromegaly or thyroid modules noted. Cardiovascular: Normal rates, S1 Normal, S2 present, without S3, S4, gallop, friction rub or murmur. No edema in lower extremities. Pulses: Brachial, Radial, Dorsalis pedis, and posterior tibial pulses 2+/4+ bilaterally Pulmonary/Chest: Respirations regular and even. Lung sounds slear on auscultation Abdominal: Obese, Soft. Bowel Sounds are active. Generalized tenderness. no mass noted. No CVA tenderness. Unable to palpate liver due to body habitus. There is no rigidity, rebound or guarding. Lymph: No cervical lymphadenopathy Neurological: CN II-XII intact Skin: Skin warm, dry and intact. No rashes. Lesions and abrasions. Psychiatric: Mood and affect normal. Calm and cooperative behavior. Judgment intact. Mediaction: None Blood work pending CT abdomen/pelvis: Hypovascular liver masses consistent with metastatic disease of unknown primary. Discussion questions: 1. What is the most likely diagnosis for the metastatic liver lesion and why? 2. What education should be provided to pt?

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