She denies nausea and vomiting blood or mucus in stool rectal pain or bleeding

She denies nausea and vomiting blood or mucus in

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denies nausea and vomiting, blood or mucus in stool, rectal pain or bleeding, or recent fever. She denies vaginal bleeding or discharge. Reports no history of inflammatory bowel disease or GERD. Denies family history of GI disorders. Her appetitehas decreased over the last few days and she is taking small amounts of water and fluids. Previously she reports regular brown soft stools every day to every other day.Objective• General Survey: Uncomfortable and flushed appearing elderly woman seated on exam table
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Student DocumentationModel DocumentationMrs. Park is a pleasant, well nourished Asian female in mild distress r/t abdominal discomfort located in lower abodment x5 days with no regularbowel movement x5 days except for diarrhea x4 times 2 days ago. Vitals: BP 110/82, T98.6, P92, RR16, O299%, Pain 6/10 CONSTITUTIONAL: Denies weight loss, fever, chills and weakness; some minor fatigue since not feeling well HEENT:cheeks slightly flushed; nasal and oral mucosa appear normal, moist and pink; Abdomen: flat, nondistended, freckles noted; transverse scar notedacross lower abdomen, and RUQ; Normoactive bowel sounds all 4 quadrants; no bruits noted; dullness noted in LLQ on percussion with positive painful grimace; spleen normal on percussion; liver at 7cm in the mid-claviclular line; tenderness noted in LLQ on light palpation; Firm, oblong mass 2x4cm noted to left lower quadrant with associated tenderness; aorta is 2cm with no lateral pulsation noted; liver is palpable at 1cm below right costal margin; spleen not palpable; bladder nonpalpable with no distention or tenderness; kidneys nonpalpable bilaterally; Bilateral Lower extremities appear normal with no edema noted; freckles also noted on BLE Cardiovascular: S1 andS2 heartsounds present with no abnormal heart
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