Sep 27, 2023, 14:12 by Sarah Moore

The patient is a 35-year-old Caucasian female who presents with a chief complaint of “my liver tests are abnormal.” At her annual gynecology visit, routine labs were drawn. A complete blood count (CBC) was normal. A comprehensive metabolic panel (CMP) revealed mild elevation of the aspartate aminotransferase at 52 U/L and alanine transaminase at 64 U/L. There was a significant elevation of the alkaline phosphatase at 320 U/L. The total bilirubin and albumin were normal. A CBC and CMP last done 3 years ago were normal.

Sep 27, 2023, 14:12 by Sarah Moore

A 20-year-old white female presented to the GI clinic with a chief complaint of “fatigue and low blood count.” She is an elite athlete. She runs cross country for a division 1 university. Approximately three months ago, she noted significant fatigue after training regimens. Two months ago, she noted steadily decreasing times for her cross country runs. She also noted daily fatigue unrelated to training. She has a lifelong history of constipation, having two to three bowel movements per week. Over the last two months her bowel habits have changed. She now has one to two daily, formed, non-bloody bowel movements. She denies any other symptoms. Specifically, no weight loss, no abdominal pain and no GI bleeding. She has no chronic medical problems and does not take any medication, vitamins or supplements. Evaluation by her primary physician revealed an Hgb of 10.8 and a slightly decreased mean corpuscular volume. Of note, she states her grandmother (originally from western Ireland) has some type of “GI disease.”

Sep 27, 2023, 14:12 by Sarah Moore

A 52-year-old white male presented to the emergency room (ER) with a chief complaint of “passing blood from my rectum.” The bleeding was acute in onset and began approximately 18 hours ago. He has had a total of four episodes of bright red blood per rectum. In the first two episodes, he passed a mixture of stool and blood; however, in the two most recent episodes, he passed only blood. He describes each episode as a “large amount of blood.” He has no other symptoms, including no abdominal pain. In the ER, his initial heart rate was 110, and his blood pressure was 98/64. He received one liter of normal saline with a decrease in his heart rate to the low 90s and improvement in his blood pressure to 110/70. Hemoglobin on presentation was 11.2. He had a normal complete blood count (CBC) and comprehensive metabolic panel (CMP) one year ago. The last colonoscopy was two years ago; it was negative for polyps and cancer. He was told he had “pockets” in his colon. He has well-controlled hypertension on lisinopril 20 mg po daily.

Sep 27, 2023, 14:12 by Sarah Moore

A 45-year-old Caucasian male presented to the ED with melena for 7 days. On further questioning, patient reported intermittent dyspepsia, nausea, early satiety and bloating for the prior 6 weeks. He had decreased his oral intake secondary to these symptoms and has had a 10-pound weight loss. He admits to dizziness. He denies fevers, chills, vomiting, hematemesis, jaundice.

Sep 27, 2023, 14:11 by Sarah Moore

A 45-year-old African American female presents to her gastroenterologist for an open access screening colonoscopy. Currently, she is asymptomatic. She has no known family history of colon cancer or colon polyps. This is her first colonoscopy. Past medical history includes hypertension, well-controlled on chlorthalidone. She exercises 4-5 times per week and adheres to a low-fat diet. She drinks 2-4 glasses of wine per week. She does not smoke or use recreational drugs.

Sep 27, 2023, 14:07 by Sarah Moore

The patient is a 34-year-old Caucasian female who presents with a chief complaint of “abnormal liver labs”. She states that over the last six months she has lacked energy and is easily fatigued. She’s an avid cyclist, however this has become more difficult due to fatigue. She has no other complaints. Due to the severity of fatigue and its impact on her regular activities, she went to her primary care physician. Her evaluation, including abdominal ultrasound, was negative except for a mild elevation of the AST and ALT at 72 U/L and ALT 90 U/L respectively. Her platelet count, albumin, bilirubin, and alkaline phosphatase are all normal.