A 58-Year-Old, Previously Healthy Man Is Evaluated Due to a 2-Month

question 291

Multiple Choice

A 58-year-old, previously healthy man is evaluated due to a 2-month history of early satiety, postprandial epigastric pain and vomiting, and unintended weight loss.  Physical examination shows cachexia and a palpable epigastric mass.  Upper gastrointestinal endoscopy reveals a large prepyloric mass causing gastric outlet obstruction; biopsy of the mass is consistent with poorly differentiated adenocarcinoma.  Abdominal CT scan reveals thickening of the gastric wall with adjacent fat infiltration, enlarged lymph nodes, and multiple hepatic metastatic lesions.  The disease is considered unresectable, and the patient undergoes laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction.  Postoperatively, he tolerates tube feeding but experiences worsening weakness.  The patient also has frequent episodes of nonsustained ventricular tachycardia.  Laboratory results are as follows: Which of the following is the most likely cause of this patient's worsening condition?

• A)Hepatic metabolic impairment
• B)Hospital-acquired infection
• C)Hypermetabolic syndrome
• D)Nutritional replenishment
• E)Paraneoplastic syndrome

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