Patient History

A 64-year-old female came to the emergency department after a pre-syncopal episode. She reported feeling overwhelmingly weak and light-headed when she got out of bed, but she did not completely lose consciousness. These episodes had been occurring recurrently for approximately one year with occasional complete loss of consciousness. Additionally, she reported infrequent episodes of bright red rectal bleeding over the last several months. Her prior evaluation included upper endoscopy and colonoscopy, but these failed to reveal a source of the bleeding. The patient’s past medical history included hypothyroidism and gastro-esophageal reflux disease. Her laboratory evaluation in the emergency department is included under laboratory results.