Case 2: Introduction

History of Present Illness (HPI)

A 48 year-old man with a past medical history of hypertension and chronic low backclipboard pain was admitted to the hospital 10 days ago with upper gastrointestinal bleeding. He had been taking ibuprofen for the past 2 months in the setting of low back pain, but is otherwise on no outpatient medications. Admission labs were notable for a hemoglobin of 9.2 g/dL but were otherwise unremarkable. Ibuprofen was discontinued. He was initiated on omeprazole therapy and underwent upper endoscopy, which revealed a duodenal ulcer.

The patient was discharged home in stable condition to follow up with Gastroenterology and Primary Care. He now returns to the Emergency Department with new lower extremity edema and decreased urination. He denies any other complaints, and has had no further evidence of gastrointestinal bleeding.

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