Patient with Abdominal Pain and Gas

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NOTE: incomplete file

Chief Complaint

The patient we interviewed is Ms. B, who is a 53 year old African American female who came to XXX Hospital last Saturday 2/26 with concerns of severe abdominal pain and excessive gas production. Today is her 3rd day of stay. Ms. B is widowed (her husband passed away in January), unemployed, lives with her mother, and has one grown child.

History of Present Illiess

Upon us interviewing her, Ms. B stated she felt a mass in her lower left quadrant accompanied with pulsating pain that radiates over her entire lower abdomen. On a scale of 1-10 she rated her pain as 10. Ms. B has had the pain for at least 18 months and the pain seems to be getting worse as time goes on. Ms. B is allowed to consume solids and liquids as part of her diet. The pain she describes abates after eating. Furthermore, her pain worsens when she goes to the bathroom and she sometimes passes blood in her stool. She experiences bouts of diarrhea and constipation. Ms. B also states that her sister had a similar problem. Ms. B also has a history of diabetes mellitus, HTN, trichomonas, hyperlipidemia, and asthma.

Her present medication list includes:

• Insulin 70/30; 25 2x daily. [ATP-dependent potassium channels (K+) close and the cell membrane depolarizes, which causes entry of glucose into muscle]

• Lovastatin 20 mg. [HMG-CoA reductase inhibitors]

• Albuterol [short-acting ?2-adrenergic receptor agonist]

• Prednisone [corticosteroid]

• Clonidine 0.3 2x daily. [direct-acting ?2 adrenergic agonist]

• Aspirin. [COX inhibitor]

• Methadone 20 mg. [synthetic opioid that is a mu-receptor agonist]

Tests and procedures:

• Colonoscopy done on the patient revealed no signs of perforation, infection, or hemorrhage.

• Urinanalysis done on 2/26 revealed high glucose levels in the urine together with trace protein.

• CBC done on 2/26 revealed decreased Hb/HCT/RBC.

• Brain CT scan done on 2/26 revealed an infarct of unknown age in the right basal ganglia. There was no evidence of hemorrhage.

• Abdominal CT scan done on 2/27 revealed an 8 mm non-calcified nodule in the right lower hepatic lobe, very small hypodense lesions in the liver, an atrophic pancreas, and a prominent common bile duct.

• ECG done on 2/27 revealed a normal sinus rhythm, ST/T wave abnormality, and QT prolongation.

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