A fully functional, independent woman who is nearly 100 years old lives with her 2 daughters. Medical status A history finds that she has: High blood pressure CAD Congestive heart failure Cataracts Hearing impairments Knee osteoarthritis Her medications are lisinopril, furosemide, ASA, and metoprolol. Presentation and examination The Patient develops abdominal pain increasing over 5 days; obstipation for 1 day. She is acutely ill and appears uncomfortable and volume depleted. On exam, shows abdominal distention, hypoactive bowel sound, and no mass is found.
Her heart is enlarged and no S3. Labs WBC = 13290 HCT = 42 Na = 128 K = 2.6 Bun/creatinine = normal An abdominal CT scan shows that the cecum is dilated to 13cm and the left image shows a possible mass in the descending colon. Recognizing the seriousness of her illness she was quickly stabilized with volume repletion. She was in…
