Case 13

48 yo F presents w/ sudden onset abdominal pain. Pain has been constant since yesterday w/ no known precipitating factors. Symptoms are associated w/ left-sided chest pain, SOB, left arm numbness and right-sided lower back pain. Pt reports no change in appetite, last BM the same morning. She has seen blood in toilet bowl intermittently 2x per week. Pt also complains of abdominal distention x 1 week. Denies any nausea, vomiting, fevers, chills, dysuria or other associated symptoms.
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Case 01

65 y/o F presents with postprandial substernal chest pain “like someone standing on her chest,” with mild SOB.  Review of systems unremarkable.  Physical exam grossly within normal limits, cardiac RRR, lungs CTAB, abdominal exam no tenderness or guarding.  EKG within normal limits.  Vitals: Temp 100.4, BP and HR within normal limits.  Laboratory work with WBC 7.57; cardiac enzymes negative x 1 set; LFTs: total bilirubin 2.5, alkaline phosphatase 140, AST 827, ALT 474, direct bilirubin 1.07. 

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