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Kenji_Ang
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Mr. H is a 65 year old white male with a past medical history significant for an MI and depression who presents today complaining of sharp, epigastric abdominal pain of 4 months duration. The abdominal pain has been gradually worsening over the past 3-4 months. The pain has not changed or worsened acutely. Mr. H seeks care for the pain at this time because he is now covered by Medicare. The pain is located in the epigastric region and left upper quadrant of the abdomen. It does not radiate. The pain is relatively constant throughout the day and night but does vary in severity. Mr. H rates the pain as 10 at its worst. Mr. H describes the pain as a sharp, burning pain. He has not tried taking any medicines to relieve the pain. The pain is not alleviated with rest. Mr. H thinks the pain may be aggravated by throwing the football, but he has also experienced the pain independent of playing football or exerting himself. The pain is not associated with food or eating, although Mr. H does endorse occasional heartburn. Mr. H thinks the pain may at times be worse on laying down, and it does wake him up at night. Mr. H denies any abdominal trauma or injury. He endorses a 5lb weight loss over the past 4 months, decreased appetite, and fatigue. He has experienced some drenching night sweats, requiring him to change his shirt but not his sheets. He describes a lump in his throat with associated dysphagia. He has experienced some nausea with the abdominal pain but has not vomited. He endorses constipation. He endorses bloody stools with some bowel movements. The blood is dark red in color and is not bright red. There is a sufficient amount of blood to turn the toilet water red. Mr. H does not know how many times per week he experiences this bleeding. He has not seen a bloody bowel movement in the past week.