Achy-Breaky QB is case #3 in House M.D. - Critical Cases.
Charlie Coutrakan a 17 year-old high school student and quarterback prospect, is admitted after vomiting blood. Trauma is soon ruled out as Charlie has no bruises. House takes the case because Charlie's father Archie is a menber of the Board of Directors and consistently votes to maintain House's department. Charlie is also accompanies by his mother Linda.
The team returns to do an environmental scan in the dark and finds bloody vomit residue, showing that this is not the first time Charlie has had this symptom. He is given one IV bag to replace fluids and after spending $350 of the budget, chronic kidney disease is ruled out.
The remaining differential is a gastric ulcer, most likely from the use of anti-inflammatories to treat aches and pains from football. After using a ward favour, a tongue depressor and 2 body meds, Charlie seems to improve. However, when his girlfriend Heather warmly squeezes his hand, he feels the bones break. It shows Charlie has osteoporosis, whhich rules out the ulcer. In addition, it appears that Charlie does not use aspirin and his gassiness runs in his family.
A further environmental scan finds ipecac syrup from the Princeton Culinary Institute. After treating Charlie with 8 digestive meds, the team can once again rule out chronic kidney disease.
Charlie is given more imaging. The team has to use one syringe, $350 of the budget, and another ward favor. However, they finally get test results on the bloody vomit and find duck liver cells. Archie has told them that Charlie was on a strict training diet of only lean meat. The team realize that Charlie has been purging after eating rich food. This allows them to rule out hypercalcemia.
At first, Charlie tries to deny that he has been breaking his training diet, but Heather finally admits that they have both been taking cooking lessons. Charlie was hiding the fact he wanted to become a chef because that career choice would mean he would not go to college to play football. Dr. House breaks the news that because of the damage the bulimia has done to his bones, he will never be able to play football. However, he predicts that Charlies esophagus will heal now that he is no longer purging.
House gets an idea and orders a full upper endoscopy. Hoewver, Charlie once again goes code blue and has to be defibrillated.
Charlie was treated with 5 body meds, 1 gauze, and $350 of the budget and 1 ward favor were used. He was diagnosed with Barrett's esophagus - the damage to his esophagus was repaired by his body with cells that were generaly found in the intestines. He needed surgery to correct the problem, but was expected to recover.