tokens: 779878634 TGCHO 9260099 612765 12/11/2003 12:00:00 AM Discharge Summary Signed DIS Report Status : Signed DISCHARGE SUMMARY NAME : A , REBAY J UNIT NUMBER : 984-98-62 ADMISSION DATE : 12/11/2003 DISCHARGE DATE : 01/08/2004 The patient has a known history of pancreatic adenocarcinoma . He is admitted at this time because of significant GI bleeding . REVIEW OF SYSTEMS : Significant for fatigue and increased abdominal discomfort . MEDICATIONS AT THE TIME OF ADMISSION : Insulin , Celexa , Protonix , Ambien and Pancreas . PHYSICAL EXAMINATION : Vital signs showed his blood pressure to be slightly decreased at 120/60 , pulse 64 , respirations 16 , temperature 98.8 , O2 sat 95 . HEENT : Evidence of anemia with being pale , but anicteric , no oral lesions . Neck supple . Lungs clear . Back without CVA or spinal tenderness . Heart regular rate and rhythm . Abdomen : Bowel sounds positive , soft , mildly tender in the epigastrium without hepatosplenomegaly , mass or tenderness . Extremities : Trace edema without cyanosis or clubbing . His hematocrit at the time of admission was 20.5 , after having been 32 one week earlier . ASSESSMENT : The assessment was that he had a GI bleed . He was transfused and then evaluated by GI . Endoscopy showed multiple angio ectasias throughout the stomach . He received multiple treatments for this over the succeeding weeks . In addition , he was transfused . His platelet count was maintained with platelet transfusion as necessary . He was treated with Octreotide to try to slow down the bleeding . Despite all these measures , his bleeding was never totally controlled . He then had an angiogram with Gel foam to try to control his GI bleed . Again , this was unsuccessful . At that point he had a change in mental status and was no longer responsive . Given this , the decision was made to make his care comfort measures only . At this point , he was made comfort measures and expired comfortably . The cause of death was a combination of GI bleeding felt to be ultimately related to his known metastatic pancreatic cancer . TA KO FOSSA , M.D. DICTATING FOR : Electronically Signed TA KO FOSSA , M.D. 02/05/2004 17:03 _____________________________ TA KO FOSSA , M.D. TR : mb DD : 01/23/2004 TD : 01/26/2004 2:16 A 612765 cc : TA KO FOSSA , M.D.