Virtual Morning Report - June 19, 2026 - Chronic Progressive Upper Abdominal Pain With Unintentional Weight Loss

I] Chronic abdominal pain: localisation to abdomen? Or elsewhere? Adrenal insufficiency- one of the thoughts. II] 50% of the biliary pain is epigastric, not RUQ III] Elevated alkaline phosphatase (with near-normal liver enzymes): think about infiltrative disorders - infectious disorders - granuloma → TB/endemic mycoses/sarcoidosis/amyloidosis; check GGT (to rule out bony involvement)!!! Solving: muscle wasting with elevated ALP with dysphagia (is there a unifying diagnosis ?) IV] Normal EGD rules out mechanical etiologies for dysphagia; thinking of motility disorders. V] Primary biliary cirrhosis (PBC): AMA positivity; liver biopsy gold standard. There are documented cases of esophageal involvement with PBC such as systemic sclerosis. VI] Relation of vitamin-D deficiency with ALP elevation: some of the elevation in ALP can be contributed by vitamin-D deficiency VII] Reynolds syndrome: co-occurrence of PBC with scleroderma. VIII] Dysphagia can be the only presenting symptom for scleroderma. This patient also presented with a “salt-and-pepper” rash.