History A 45-years-old man consults his general practitioner with a 6-months history of reduced appetite and weight loss, from 78 to 71 kg. During the last 3 months, he has had intermittent nausea, especially in the mornings, that has been accompanied by vomiting on several occasions. For 1 month he has noted swelling of his ankles. He has had no abdominal pain. He has no relevant past history and no known family history, as he was adopted. He takes no medication. From the age of 18 years, he has smoked 5–6 cigarettes daily and drunk 15–20 units of alcohol per week.
He has been a chef all his working life, without exception in fashionable restaurants. He now lives alone as his wife left him a year ago. Examination He has plethoric features. There is pitting edema of his ankles. He appears to have lost weight from his limbs, but not his trunk. He has nine spider naevi on his upper trunk.…
