Marcus, Maria and John: Case 1

Marcus Chan

Marcus Chan is a 19-year-old college student who comes to the Student Health clinic after 2 days of vomiting and abdominal pain.

He has been participating in his university’s Spring Rush for fraternity membership and three days ago drank alcohol at a rush party until he blacked out. He says his friends took him home, observed him vomiting several times, and gave him Tylenol and Gatorade before he passed out. He awoke the next morning “feeling hungover” and with nausea, vomiting, and belly pain that have not improved with time as his hangover improved. He is vomiting even when he tries to drink water or juice and can’t hold down food at all for the last 2 days. He came in because he is worried he has an ulcer from drinking because he is feeling too dizzy and weak to walk to the dining hall and because the pain is too bad to let him sleep, even with Tylenol and Motrin.

Exam: T 99.1 HR 100 sitting 125 standing  BP 106/55 sitting 90/45 standing SpO2 99% on room air. Weight 260 lbs., BMI 35

Gen: pale, tired appearing, obese

HEENT: scleral icterus, flat neck veins, mucous membranes dry

Chest: tachycardic, lungs clear, heart RRR, no murmurs or gallops

Abdomen: soft, mildly distended, tender to palpation and percussion, no guarding, no bowel sounds after listening for 60 seconds

Rectal/GU: testes in normal position and nontender, no hernias, rectal exam with brown stool, guiac negative

Extremities: cool, no edema

With his concerning story and exam, Marcus is advised to go to the local hospital for further assessment and treatment. The student health center physician calls to give the emergency department Marcus’s information. There, the history and physical is stable and labs are as follows:

ABG:

U/A:

Abdominal ultrasound shows normal common bile duct diameter and gallbladder of normal size with visible sediment Ultrasonic Murphy’s sign is negative.

Marcus is admitted to the hospitalist service for further management.