Final Diagnosis

  • Hepatic Flexure Intramural Colon mass further evaluation needed
  • Partial Small Bowel Obstruction
  • Vitamin D deficiency
  • AKI on CKD stage 3-4 (Baseline not known) likely prerenal Azotemia secondary to dehydration

Take Home Teaching Points

  • Patient presenting with cyclic constipation and diarrhea should be worked up first for Partial Bowel Obstruction
    • Infectious causes are unlikely to cause constipation
    • Inflammatory syndromes would be next on differential
    • First imaging should be Abdominal Xray
  • Colonic Wall Masses
    • Check Cancer markers, CEA
  • Causes of Hypocalcemia
    • First correct for albumin
    • Check Phosphate, Vitamin D, PTH
    • Hypoparathyoidism
    • Vitamin D deficiency
    • Pseudohypoparathyroidism

– Copyright Dr. Geetha Krishnamoorthy ABIM Board Review Study Guide

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