A male in his late thirties presented with a chief complaint of abdominal pain. The patient reported 3 days of worsening, generalized abdominal pain with constipation that had progressed to obstipation. The patient also admitted to increased lethargy over the past 6 months. He denied nausea, vomiting, depressed mood and any other psychiatric or neurologic complaints.
Past medical history It was significant for gastrointestinal reflux and chronic constipation. The patient denied taking any medications regularly, and his social and family histories were non-contributory. On presentation, the patient had blood work drawn with the following results: WBC count was 5.1k/μl, hemoglobin 9.6 g/dl, hematocrit 28.2%, platelet count 167k/μl Total bilirubin 1.0 mg/dl, direct bilirubin 0.3 mg/dl, AST 95 IU/l, ALT 87 IU/l Alkaline phosphatase 64 IU/l, GGT 28 IU/l, LDH 377 IU/l, amylase 55 U/l Lipase…
