Case 2
45 y.o. African American male with an intussusception
Brandi Weaver, PA-S
Bethel University
History of Present Illness
On 8/3/2015 a 45 year old African American male presented to the ER with a chief compliant of diffuse abdominal pain and trouble having a bowel movement. The patient stated that he was experiencing rectal pain with bloody stools. He also complained of feeling his bowels pulling. The patient stated that he has lost roughly 40 pounds in the past month without trying to lose weight. He stated that this has been going on for 2 months now and he has dealt with it intermittently but is has recently gotten much worse. He also stated that he has a family history of colon cancer and denies any follow-up.
Social History The patient denies any illicit drug use and tobacco use but stated that he drinks alcohol. He stated that he drinks about twelve beers a week. Review of Systems The review of system was insufficient with the exception of the gastrointestinal system. The gastrointestinal system was positive for abdominal pains and was negative for nausea, vomiting and anorexia. Physical Exam The patient vitals are as followed: blood pressure 134/86, Pulse 67, Temp 98.3, Resp 18, height 5’9, weight 145 lb, and SpO2 98%. The pt appears well developed and well-nourished in no distress. The HENT were all normal. The cardiovascular system had normal rate, regular rhythm, normal heart sounds and intact distal pulses; no murmur was heard. The pulmonary/ chest presented with normal effort and breath sounds normal with no respiratory distress. He has no wheezes. The Abdominal exam present a soft abdomen with normal bowel sounds. He exhibits no mass. There is no tenderness. There is no rigidity, no guarding, no CVA tenderness, no tenderness at McBurney's point and negative Murphy's sign. The musculoskeletal and neurological exams were both insufficient. The skin exam was normal as the skin was dry and warm with no pallor. Lastly, the psychiatric exam was normal as the patient has a normal mood and affect. Labs The patient lab work had a lot of abnormality. The patient had abnormal findings for BUN/Creatinine Ration of 8.2, total Bilirubin of 1.3, and ALT of 11. The patient CBC with differential included the following: RBC 3.72, Hemoglobin 7.1 Hematocrit 25.7, MCV 69.1 , MCH 19.1, MCHC 27.6, RDW 50.3, Platelet 523 , Monocyte Absolute 0.78 , Basophil Absolute 0.11, Immature Neutrophil Absolute 0.02 , Monocyte Percent 8.5, Basophil Percent 1.2 , Immature Granulocytes % 0.2. An urinalysis auto microscopic was order and here are the findings: specific Gravity, UA 1.060 and urobilinogen, UA 1.0. Imaging The imagining studies used to make the diagnosis were a CT and KUB X-ray. Both proved to be valuable resources in the assessment of this case. A KUB x-Ray was order and it showed a sausage like sign. Please see the image below. A CT with contrast was ordered and there was a short segment of intussusception involving the ascending colon secondary to a mass lesion. There was wall thickening involving the rectum which may be inflammatory but a synchronous tumor is not excluded as there is suggestion of a possible associated exophytic mass. There were multiple …show more content…
These infectious conditions include lymphoid hyperplasia, Kaposi’s sarcoma, and non- Hodgkin’s lymphoma. (Marinis and Samanides, 2009)
Signs and Symptoms
The presentation of intussusception is different depending on the population of the patients. Pediatric patients seem to have more signs and symptoms than adult patients. The signs and symptoms of intussusception in the adult population is nonspecific. However, the most common symptom is intermittent abdominal pain. Other symptoms included nausea, vomiting, and diarrhea. Adult patients can also present with signs and symptoms that mimic partial bowel obstruction such as melena, weight loss, fever and constipation. Lastly, some adult patients can present asymptomatic. (Taylor and Lalani, 2013)
Infants with intussusception can present with loud crying, knees to chest and intermittent pain. The most common and key sign of intussusceptions in infants is the “currant jelly” stool. Currant jelly stool is a mixture of blood and mucus. Other symptoms include vomiting, lethargy diarrhea, fever, constipation. There may be a palpable lump in the infant abdomen. (Miller and Shrier,
45 y.o. African American male with an intussusception
Brandi Weaver, PA-S
Bethel University
History of Present Illness
On 8/3/2015 a 45 year old African American male presented to the ER with a chief compliant of diffuse abdominal pain and trouble having a bowel movement. The patient stated that he was experiencing rectal pain with bloody stools. He also complained of feeling his bowels pulling. The patient stated that he has lost roughly 40 pounds in the past month without trying to lose weight. He stated that this has been going on for 2 months now and he has dealt with it intermittently but is has recently gotten much worse. He also stated that he has a family history of colon cancer and denies any follow-up.
Social History The patient denies any illicit drug use and tobacco use but stated that he drinks alcohol. He stated that he drinks about twelve beers a week. Review of Systems The review of system was insufficient with the exception of the gastrointestinal system. The gastrointestinal system was positive for abdominal pains and was negative for nausea, vomiting and anorexia. Physical Exam The patient vitals are as followed: blood pressure 134/86, Pulse 67, Temp 98.3, Resp 18, height 5’9, weight 145 lb, and SpO2 98%. The pt appears well developed and well-nourished in no distress. The HENT were all normal. The cardiovascular system had normal rate, regular rhythm, normal heart sounds and intact distal pulses; no murmur was heard. The pulmonary/ chest presented with normal effort and breath sounds normal with no respiratory distress. He has no wheezes. The Abdominal exam present a soft abdomen with normal bowel sounds. He exhibits no mass. There is no tenderness. There is no rigidity, no guarding, no CVA tenderness, no tenderness at McBurney's point and negative Murphy's sign. The musculoskeletal and neurological exams were both insufficient. The skin exam was normal as the skin was dry and warm with no pallor. Lastly, the psychiatric exam was normal as the patient has a normal mood and affect. Labs The patient lab work had a lot of abnormality. The patient had abnormal findings for BUN/Creatinine Ration of 8.2, total Bilirubin of 1.3, and ALT of 11. The patient CBC with differential included the following: RBC 3.72, Hemoglobin 7.1 Hematocrit 25.7, MCV 69.1 , MCH 19.1, MCHC 27.6, RDW 50.3, Platelet 523 , Monocyte Absolute 0.78 , Basophil Absolute 0.11, Immature Neutrophil Absolute 0.02 , Monocyte Percent 8.5, Basophil Percent 1.2 , Immature Granulocytes % 0.2. An urinalysis auto microscopic was order and here are the findings: specific Gravity, UA 1.060 and urobilinogen, UA 1.0. Imaging The imagining studies used to make the diagnosis were a CT and KUB X-ray. Both proved to be valuable resources in the assessment of this case. A KUB x-Ray was order and it showed a sausage like sign. Please see the image below. A CT with contrast was ordered and there was a short segment of intussusception involving the ascending colon secondary to a mass lesion. There was wall thickening involving the rectum which may be inflammatory but a synchronous tumor is not excluded as there is suggestion of a possible associated exophytic mass. There were multiple …show more content…
These infectious conditions include lymphoid hyperplasia, Kaposi’s sarcoma, and non- Hodgkin’s lymphoma. (Marinis and Samanides, 2009)
Signs and Symptoms
The presentation of intussusception is different depending on the population of the patients. Pediatric patients seem to have more signs and symptoms than adult patients. The signs and symptoms of intussusception in the adult population is nonspecific. However, the most common symptom is intermittent abdominal pain. Other symptoms included nausea, vomiting, and diarrhea. Adult patients can also present with signs and symptoms that mimic partial bowel obstruction such as melena, weight loss, fever and constipation. Lastly, some adult patients can present asymptomatic. (Taylor and Lalani, 2013)
Infants with intussusception can present with loud crying, knees to chest and intermittent pain. The most common and key sign of intussusceptions in infants is the “currant jelly” stool. Currant jelly stool is a mixture of blood and mucus. Other symptoms include vomiting, lethargy diarrhea, fever, constipation. There may be a palpable lump in the infant abdomen. (Miller and Shrier,