Ms. P.A. is a 36 year old female who presents to the ED with abdominal pain, fatigue, and jaundice. P.A. states she had been feeling increasingly tired over the past few weeks and recently had a friend point out the yellow tone to her skin. P.A. says that her abdominal pain started a couple weeks ago. P.A. complains that she cannot stay in the hospital for long because she is afraid she will start to have symptoms of withdrawal from opiates. When assessing the patient’s gastrointestinal and urinary complaints, P.A. states that her stools have been loose and clay colored and that her urine looks like tea. P.A. has scratch marks on her arms and legs, states that she has been feeling “itchy”. She said that she had a cut on her arm that wouldn’t stop bleeding a couple days ago.
Medical history
- multiple treatments of chlamydia and gonorrhea “over the years”
- Fibroids with hysterectomy in 2016
- IVDU (heroin)
- Pancreatitis
- MRSA
- anxiety
Family medical history
- father died in MVA in 1990
- mother has hypertension and diabetes age 54
- no siblings
- maternal grandmother died of a stroke at age 67
- maternal grandfather died of liver cirrhosis age 75
Social history
- patient currently unemployed
- multiple sex partners
- four children whom live with their grandmother
- has been doing heroin and other elicit drugs for ten years with some short periods of sobriety when in rehab