Scenario 2, Part 2 of 3

Office record of Dr. Piper from one year ago

"…has very difficult history to make out. …states has been doing a lot of heavy lifting…working…as result, often passes small amount of mucous…occasionally little bit of blood by rectum when she first gets up in the morning…passes mucous first…perhaps…hour or two…normal bowl movement. Abdominal exam unremarkable. Rectal exam unremarkable with a negative stool…am puzzled by symptoms…suppose patient may have diverticular disease…going to try her on Metamucil…is to return in two weeks…will obtain barium enema.

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