Resumen

NATAL, Rebeca Martins  y  ROSA, Inês Andrade. Nausea during Christmas: the role of the family physician in the diagnosis of severe illness. Rev Port Med Geral Fam [online]. 2018, vol.34, n.4, pp.219-223. ISSN 2182-5173.

Introduction: The family physician (FP) is often the patient's first contact with health system, dealing with diseases in early stages when symptoms are still nonspecific. With this case report, we intend to promote the reflection about the role of FP in the several stages of the process of diagnosis, and about the characteristics intrinsic to general and family medicine specialty that facilitate it. Case report: We present the case of a 48-years-old female, integrating a reconstructed family of medium socioeconomic status, with history of depressive syndrome (medicated with fluoxetine), in climacteric. She presented with nausea, bloating, and generalized pruritus for the last 10-days and a single vomit on Christmas Eve. The physical examination revealed mild abdominal pain in the epigastrium. She was prescribed according her symptoms and ordered blood tests and an abdominal ultrasound. The patient returned 3 days later with scleral icterus and acholic stools, maintaining nausea. No choluria or fever were present. Complementary diagnostic tests showed conjugated hyperbilirubinemia; ultrasound revealed pronounced dilation of the common bile duct, a nodular image in the pancreatic body/tail and multiple adenopatic conglomerates. The patient had no evident consumptive symptoms. Abdominal computed tomography revealed an adenopatic conglomerate implicating the pancreatic head, most likely to be associated with a lymphoproliferative disorder. Patient was urgently referred to the Hematology-Oncology consultation where the final diagnosis was established: non- Hodgkin's diffuse large B cell lymphoma. She completed 8 sessions of chemotherapy and is currently under remission. Comment: Although the FP's decision-making process is mainly based on the community epidemiology of diseases and patient's sociocultural context, the diversity of diagnostic hypothesis that may result from the natural course of disease can't be forgotten nor underestimated. The FP should rely on the advantages of health care continuity and accessibility, thus enhancing his diagnostic role.

Palabras clave : Family physician; Primary health care; Lymphoma.

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