Cerritos Community College Gastrointestinal Disorders Case # 1R. Torres is a 53 year-old male with a two-year history of epigastric discomfort, bloating, and gas that have been increasing over the past four months. He states that large meals and lying down make his symptoms worse, but antacids offer some short-term relief. He denies nausea, vomiting, irregular bowel habits, and weight loss. However, he does admit to skipping some meals to avoid dysphagia.   Meds:

cc: "I can’t eat or sleep anymore without getting heartburn and sometimes my chest hurts."

Case #2G. Arnold is a 60 year-old man who presents with a one-day history of melenic (dark) stools, abdominal pain, and constipation. Several weeks ago, he noticed the gradual onset of a localized gnawing epigastric pain that has occurred daily, wavering in intensity, and increased at night and between meals. Mr. Arnold states that ingesting food or taking antacids seems to decrease the pain. Yesterday, for the first time, he noticed black, tarry bowel movements. He denies any history of PUD, GI bleeding, and has not experienced anorexia, weight loss, nausea or vomiting.   Meds:

cc: "My stomach has been burning for weeks and yesterday my stools turned black."

Case #3E. Vance is a 38 year-old woman who has been having three to five non-bloody stools per day varying from soft to "loose" for the past 2 weeks. She began having mild bloating and abdominal cramping over the past 48 hours. The patient has been self-treating with occasional OTC antidiarrheals without success. Within the past 24 hours, she began experiencing mild vomiting and fatigue. The patient had one previous similar bout of these same symptoms approximately six months ago and attributed that episode to a "virus" and sought no medical care.   Meds:

cc: "I’m vomiting, having diarrhea and stomach cramps, and I feel weak."

Case #4D. Brown is a 66 year old woman who comes to the cancer center clinic to begin chemotherapy with paclitaxel 135 mg/m2 infused over 3 hours, followed the next day by cisplatin 75 mg/m2 infused over 2 hours. She is one month s/p surgical debunking of an adenocarcinoma of the ovary with extensive involvement of the colon, necessitating the creation of a colostomy.   Meds:Percodan prn pain

cc: "I’m nauseated"