Matthew J. Mckinley, MD

An 85-year-old woman presented to the emergency department with epigastric pain and nausea for 2 days. She denied vomiting, fever, or early satiety. The patient stated she had lost 10 pounds over the past 3 months. A CT scan of the abdomen revealed a 1 cm low attenuation lesion in the second portion of the duodenum.

A 68-year-old man with a history of small-cell lung cancer with bony metastases was admitted with diarrhea. The patient had completed chemotherapy one week earlier with cisplatin and etoposide, along with radiation therapy, and irinotecan (Camptosar). The patient was found to be neutropenic.

This 47-year-old man underwent surveillance colonoscopy for a history of an adenomatous polyp. He has a history of hemorrhoids and occasional bright red blood on the toilet tissue. There is no history of diarrhea, constipation, or abdominal pain.

This photograph is from an upper gastrointestinal endoscopy on a 15-year-old male. He has a history of a total colectomy and is being evaluated for iron deficiency anemia. He denies abdominal pain, weight loss, and melena. He notes occasional bright red blood on the toilet paper but denies hematochezia.

A 72-year-old man is referred for evaluation of abnormal liver chemistries. He has a history of unresectable pancreatic cancer (adenocarcinoma of the head).

Early metabolic imaging with positron emission tomography (PET) identifies responders to neoadjuvant chemotherapy for advanced adenocarcinoma of the esophagogastric junction

The patient is referred for evaluation of this chronic progressive dysphagia. Upper gastrointestinal endoscopy is performed. The photograph is taken in the esophagus.

A 45-year-old man with chronic ulcerative colitis for more than 10 years presents with diarrhea for 4 days. The diarrhea is nonbloody, watery, and associated with abdominal pain, nausea, vomiting, low-grade fevers, and chills for 2 days. The abdominal pain was diffuse, but worse in the right upper quadrant.

Barrett's esophagus and documented high-grade dysplasia (HGD)

This 72-year-old woman undergoes surveillance colonoscopy. She has a history of small colonic adenomas removed from the distal colon and of a sessile hyperplastic polyp in the cecum. Prior biopsies have demonstrated only hyperplastic changes and no evidence of adenomatous or dysplastic features. Her last colonoscopic examination was more than 3 years ago.

A 48-year-old man is referred for evaluation. He has a history of hypercholesterolemia and obesity. Treatment with cholesterol-lowering medication was associated with elevated liver chemistries. When the elevated liver chemistries persisted

A 66-year-old Asian woman presents with chronic heartburn and epigastric discomfort. She has suffered with these symptoms most of her adult life and underwent multiple upper gastrointestinal series in her homeland, China. The radiologic

A 75-year-old attorney presents with intermittent rectal bleeding. He had refused routine sigmoidoscopy in the past. His primary care physician was his friend, and he had convinced him to at least send in stool specimens for occult blood testing. Three years ago, his primary care physician informed him that "several" of the tests were positive and that he required evaluation. The patient refused and his doctor retired.

A 72-year-old woman with chronic obstructive pulmonary disease (COPD) presents with abnormal liver chemistries. She denies recent abdominal pain but recalls "gallbladder problems" after childbirth approximately 40 years ago. She has not lost any weight and denies fever. There is no history of nausea or vomiting.

A 68-year-old man is referred for further evaluation and treatment of jaundice. He describes pruritus, intermittent mild midabdominal discomfort, and progressive weight loss. There is no history of fever. His history is significant for renal cell carcinoma with pulmonary metastasis.

A 51-year-old man presents with iron deficiency anemia and occasional blood in his stool. He has no abdominal pain, no change in appetite, no diarrhea or constipation, no melena, and no loss of weight. The patient denies any nausea and vomiting.

A 65-year-old man with a history of a "bleeding ulcer" 7 years earlier presents with complaints of progressive dysphagia for solids and liquids over the past 4 months. The patient states that he has had a 40-pound weight loss during this time, but denies any fevers, chills, abdominal pain, melena, or anorexia. He states that recently he cannot go to his favorite restaurant, as whenever he eats he experiences severe coughing fits. He also describes regurgitation of undigested materials soon after eating.

A 49-year-old woman presents with increasing constipation. She has noted intermittent bright red blood on the toilet tissue. She denies abdominal pain, anorexia, weight loss, and fever. She has a long history of constipation treated with "natural, herbal remedies." Her medical history is unremarkable. She is taking no other medications. Her surgical history is positive for hysterectomy for fibroids. Her family history is positive for colon cancer in her maternal grandmother.

A 60-year-old attorney presents with chronic heartburn and regurgitation. His symptoms have steadily increased over the last 2 years, and he is currently using daily therapy with a proton pump inhibitor. There is no history of gastrointestinal bleeding, dysphagia, or weight loss.

Colonoscopy was performed on this asymptomatic 72-year-old man with colonic adenomatous polyps.

This endoscopic photograph was obtained during an upper-gastrointestinal endoscopy on a 60-year-old gentleman with epigastric abdominal pain and melena. The photograph was taken in the stomach.