46 year old female with chronic diarrhea, weight loss and
lower extremity edema.
History of the Present Illness:
Nine years ago the patient was diagnosed with gastric adenocarcinoma
and underwent a subtotal gastrectomy with gastrojejunostomy. She also
received chemotherapy and radiation at that time. The patient reports
she had been relatively well up until one year ago at which time she presented
to an outside hospital with complaints of nausea, vomiting and abdominal pain.
She was found to have a complete small bowel obstruction. She underwent
exploratory laparotomy and was found to have extensive necrotic small bowel
which was removed. An operative report stated that only a short (unspecified)
segment of viable small bowel remained intact. The colon was not removed.
The patient's diarrhea has been present for 1 year and is described as oily.
She notes oil droplets that are difficult to flush. She has up to 6
bowel movements per day. Her bowels move most frequently right after meals.
She has lost 30 lbs unintentionally over an 8 month period. Lower extremity
swelling has been present for about 8 months and is worsening. She eats
2-3 regular meals a day supplemented with two cans of high calorie enteral
feeding supplements per day.
Previous Medical Diagnoses, Hospitalizations, and Operations:
Hypothyroidism (1990)
Medications:
Levothyroxine
Promethazine
Lansoprazole
Calcium
Personal and Social History:
No excessive alcohol or tobacco use; no substance abuse; no
travel; stable family and finances
