Case 1: Introduction

History of Present Illness (HPI)


A 55-year old Caucasian male presents with the complaints of passing 7-10, mucus filled, loose bowel movements/day over the last 3 months. He is also bothered by intermittent rectal pain, nocturnal bowel movements, and has had 2 episodes of soiling himself since he wasn’t able to make it to the bathroom in time. Over the last month he has also noted streaks of bright red blood mixed with the brown stools. He denies abdominal pain, nausea, vomiting, fevers or weight loss. He complains of fatigue and generalized joint aches over the last 6 months for which he takes tab ibuprofen 400mg twice/week. He traveled to Haiti for vacation 4 months ago and upon returning got treated with a course of ciprofloxacin for a urinary tract infection.

Past medical and surgical history is notable for hypertension, atrial fibrillation (not on anticoagulation) and prostate cancer status post prostatectomy and radiation therapy 1 year prior. He is on daily aspirin and amlodipine. There is no notable family history of gastrointestinal pathology. He has a 40 pack year smoking history and quit on his cardiologist’s advice 6 months ago. His last colonoscopy was 3 years prior for colon cancer screening and was unremarkable.

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