Part I.

Chief Complaint: "My belly keeps getting tighter."

History of Present Illness: Mr. Madison is a 66 year old male with a past history of Coronary Artery Disease (CAD), Hypertension (HTN), and Type II Diabetes Mellitus (DM) who noticed bilateral lower extremity swelling and increased abdominal girth starting three weeks ago. Soon after, the patient began experiencing shortness of breath and intermittent abdominal pain. The pain was dull and diffuse without radiation. A week prior to admission, the patient developed orthopnea. Four days prior to admission the patient saw his primary care physician who prescribed oral furosemide (a diuretic). The fluid around his ankles and legs decreased, but he did not notice any change in his abdominal girth. He notes a decreased appetite for 3-4 days prior to admission. The patient reports no vomiting, jaundice, or increased frequency of urination. The day of admission he came to the Veterans Affairs emergency room because his abdomen continued to increase in size.