Chier Campleint “Blood in strool for the pest 3 months” Hetory of Preeent Inness: A 52…

chier Campleint “Blood in strool for the pest 3 months” Hetory of Preeent Inness: A 52 year-old Native American women with obselty and hypothyroldiem presents to an ungent care citic affiliated with har PCP-a prectice for rectal bleading for the peast 3 months, Initiaty, it heppened about ance a weak during a bowel movement but wee currently occuring deliy with all bow I move mants, Sha describes the blood as approafrnately 1 teaspoon, dark red, and missed in the atool, She denies any associated rectal or abdominal peln, and her bowel movements are regular mery dey without change, atthough they do seem thinner, which she ettributes to starting a low-carbohydreme dist 4 months aga. She releye a history of Internal hernorinoide aiter the birth of her deughter 20 yeare ago, with reare bleading throughout the years that atwere inpreves within a des of spolying over-the-counter hemornold creem, Despite using thla craw delly now, there hes been no inprevernant incurrent symptime. Though sho wee referred for coloroecopy screaring at se sha never schoduled it because sha wes “atraid of the prep” and did not want to inles a whole devy of work, She ratese she called her reguler PCP 3 months ego about her b eding. “He told to me that my Insurence a rows me to see the gestroenterologiti without a referrel, be I ahound se there and get a coloncecopy done. “The procedure ts schedund in 3 weaks, the aarilest a ble for the “routhe screaning” referred sent. The patient seaked whether “the take-home tesk” or “Winteal coloncecopy” cound be ordered todey for quicker resume. Review of System : The patient endoress fatigue and weight tose of 12 ibe in 4 morthe, which she attributes to diating. and occesionel night eweats, which abe attributee to menopeuse. She denles forer or chille. She endorese increasing 808 when welling upetaire or hills for the past month but devies any cheet peln, papitations, or syncope; and oreae dizdiness when stending up quicity but de headeche, newses/voriting, dienhes, or molene; devies erry cigsuris, hernaturia, veginal bleeding or dechemge, or pabic pain; danise any increased bruising or swoilan tyrnph nodes; denles any aidn reshee, testons, or itching and denles insornals, endety, or depression. Retereact History The patient has atruggied with obselty since her preguency est age 32, aiter which she wes diegreed with hypothyroidern, She has taken lexchtyruarine 112 meg delity for 20 years but talse no other medications or supplements. She hea no prior history of heart, lung, Gl, or bleeding disordere, and she has no prior surgerise or hospitaltzations. Her perente are alive and healthy in their texts 70s; she helieve her macemel greadmother ded in her fils of “eorne idnd of stomach cancer.” There is no fambly history of heart disaase, diabates, or bleeding disorder. She is married and seausily acthe. She dose not smoke or use any recreetional drugs. She diffice 2 sesses o’wine every right with diveer, None. Medicationar Levothynodne 112 meg QD.