A 61-year-old lady was admitted to the hospital with a chief complaint (CC) of constipation and bilateral (B) knee pain for 2 weeks. She was diagnosed with severe osteoarthritis (OA) and opioid pain medications were started. The patient's last bowel movement (BM) was one week prior to admission and she did not have any BM after that despite multiple laxatives. She also admitted to feeling depressed. Past medical history (PMH) Hypertension (HTN), gout, COPD, hypothyroidism following a radioactive iodine treatment for hyperthyroidism in the remote past. Family history (FH ) Gout, stroke. Physical examination Obese lady in NAD. VS 36.9-16-53-170/95.
Chest: CTA (B). CVS: Clear S1S2. Abdomen: Soft, NT, ND, absent BS. Extremities: the knee examination showed bilateral knee swelling, left greater than right. No joint fluid. Joint tenderness was present. No pitting edema or cyanosis. Laboratory…
