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Medicine Grand Rounds Clinical Vignette

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Medicine Grand Rounds Clinical Vignette Becky Naoulou, MD PGY-2 May 28, 2013 UNITED STATES DEPARTMENT OF VETERANS AFFAIRS Patient is a 60 year old man with juvenile ... – PowerPoint PPT presentation

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Title: Medicine Grand Rounds Clinical Vignette


1
Medicine Grand Rounds Clinical Vignette
  • Becky Naoulou, MD
  • PGY-2
  • May 28, 2013

2
Chief Complaint
Patient is a 60 year old man with juvenile
diabetes and ESRD who presents for a screening
colonoscopy.
3
History of Present Illness
  • Patient was undergoing evaluation for a kidney
    transplant. Was referred for a screening
    colonoscopy as part of the pre-transplant
    work-up.
  • He denies any complaints. He never had a
    colonoscopy before. Reports he has regular daily
    bowel movements. Denies any change in stool
    caliber or color. Also denies red blood or black
    stool.

4
Additional History
  • Past Medical History Juvenile DM, ESRD on
    dialysis
  • Past Surgical History denies
  • Social History Lives alone, works as a
    carpenter. Denies tobacco, alcohol and illicit
    drug use
  • Family History no family history of GI
    malignancy. His brother may have had polyps,
    gets frequent colonoscopies but patient does not
    know further details.
  • No Known Drug Allergies
  • Medications glargine at bedtime, aspart sliding
    scale

5
Physical Examination
  • General White man, appearing stated age, no
    acute distress.
  • Vital Signs T 98.6 BP116/76 HR70, RR14 and
    O2 sat100 on RA
  • Rectal exam with brown stool, no masses or
    hemorrhoids
  • Remainder of the physical exam was also normal

6
Laboratory Findings
  • CBC, hepatic panel, and coagulation studies were
    within normal limits
  • Basic metabolic panel remarkable for a creatinine
    3 (at patients baseline)

7
Colonoscopy
  • A colonoscopy was performed which had good prep
    to the cecum, confirmed by appendix and the
    ileocecal valve. In the sigmoid colon, there was
    a large pedunculated polyp 3 cm in size. This
    was resected with a hot snare polypectomy and
    sent to pathology.

8
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9
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10
Pathology/Final Diagnosis
  • Tubulovillous Adenoma with High-Grade Dysplasia
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