Name: Deva Subin Joshua Student ID: 211000452 Section: 3A

Chief Complaint: Dark-colored Stools

History of Present Illness:

G.G., a 50/M was noted to have soft, dark colored stools amounting to approximately 50cc per
bowel movement for 3 episodes a day prior to admission. This condition was associated with slight
shortness of breath upon exertion. The patient did not seek consult, did not take any medications and
tolerated his condition. On the day of admission, the patient again had dark colored stools with 2
episodes that was now associated with worsening of shortness of breath and body malaise thus sought
consult and admission.

Past Medical History:

- Hypertensive for 10 years and maintained on Losartan 50mg/tab daily taken with good
compliance
- Diagnosed with Gouty Arthritis for 8 years now with frequent flares and is on Febuxostat
40mg/tab daily taken with good compliance. The patient also takes Etoricoxib 120mg/tab
almost daily and takes Naproxen Sodium (Skelan) 3x/day during flares

Social History:

- Alcoholic Beverage Drinker consuming 2 liters of Red Horse beer every other day
- Cigarette Smoker consuming 15 sticks/day for almost 25 years

Family History:

- Father is a known hypertensive and is diagnosed with Colorectal Cancer

- Mother is a known diabetic

Physical Examination:

General Appearance: Patient is seen weak, with shortness of breath and responsive however drowsy
Vital Signs:
BP – 100/60 mmHg
HR – 115 bpm, regular
RR – 26 cpm
T – 36.5C
02sat – 93%, room air

HEENT: pale palpebral conjunctivae, anicteric sclerae

C/L: equal chest expansion, clear breath sounds
CVS: distinct heart sounds, no murmurs, tachycardic, regular rhythm
ABD: flabby, normo-active bowel sounds, soft, non-tender, no masses
EXT: cool, no edema
NEURO: within normal limits
Initial Laboratory Exams:

Complete Blood Count

WBC 8.7 10x9/ L
Neutrophils 70
Lymphocytes 25
Monocytes 3
Eosinophils 2
Basophils 0
Hemoglobin 6 g/ L
Hematocrit 40%
Platelet 200

Fecal Occult Blood Test: positive

Case Questions:

1. What is your primary question and your basis? (10)

Answer:
The patient presents with dark stools, associated with worsening shortness of breath, and is found
to be positive for fecal occult blood. These symptoms indicate a potential gastrointestinal bleed
and associated complications.

2. Give 3 differential diagnosis and your basis for each. (15)

Answer:
• Gastrointestinal Bleeding:
Dark stools, positive fecal occult blood test, and weakness suggest possible upper
gastrointestinal bleeding.
• Anemia:
Pale palpebral conjunctivae, low hemoglobin and hematocrit levels in the complete blood count.
• Heart Failure:
Shortness of breath, tachycardia, and low oxygen saturation indicate possible cardiac
involvement.

3. Interpret the given laboratory findings. (10)

Answer:
Complete Blood Count:
Low hemoglobin and hematocrit levels indicate anemia, supporting the suspicion of
gastrointestinal bleeding.
Fecal Occult Blood Test:
Positive result suggests active bleeding in the gastrointestinal tract.

4. What are your other diagnostic modalities and laboratory exams? (20)
Answer:
Laboratory Exams:
• Upper Gastrointestinal Endoscopy (UGIE):
To identify the source of gastrointestinal bleeding.
• Chest X-ray:
To assess for signs of heart failure.
• Liver Function Tests:
To assess liver function due to alcohol consumption.
 5. What is your final diagnosis and your basis for which? (15)
Answer: Gastrointestinal Bleeding secondary to Peptic Ulcer Disease
UGIE reveals a bleeding peptic ulcer, explaining dark stools and anemia. Alcohol consumption may
contribute to ulcer development.

6. How will you manage this patient? (10)

Answer: Immediate Measures
• Administer intravenous fluids for volume resuscitation.
• Blood transfusion for anemia correction.
Medical Treatment:
• Proton pump inhibitor (e.g., omeprazole) for peptic ulcer.
• Address alcohol cessation.
• Monitor and manage gout and associated medications.

7. Provide a Concept Map. (20)

Answer: