tokens: Admission Date : 2012-04-30 Discharge Date : 2012-05-14 Date of Birth : 1956-11-04 Sex : M Service : O-CMED CCU HISTORY OF PRESENT ILLNESS : The patient is a 55 - year-old male with recently diagnosed abdominal carcinomatosis . The patient presented with abdominal pain and bloating and was found to have a large omental mass . Biopsy revealed adenocarcinoma . Histochemical stains are consistent with hepatobiliary origin . Endoscopies were negative except for an extrinsic mass present on the stomach . The patient presents with increased abdominal pain and poor oral intake as well as generalized weakness . On presentation , the patient denied chest pain , shortness of breath , and cough . PAST MEDICAL HISTORY : 1. Benign prostatic hypertrophy . 2. Osteoarthritis . 3. Gastrointestinal adenocarcinoma ( as noted in History of Present Illness ) . MEDICATIONS ON ADMISSION : Colace , Senna , Dulcolax , Tylenol , oxycodone as needed , Ambien , and Protonix . ALLERGIES : No known drug allergies . FAMILY HISTORY : Mother had adrenal cancer . Father had coronary artery disease . SOCIAL HISTORY : The patient was employed as a salesman . He denied the use of tobacco and drugs . He uses alcohol occasionally . The patient is married with two children . REVIEW OF SYSTEMS : Review of systems was significant for progressive abdominal discomfort , decreased oral intake , and weakness in the past nine weeks . PHYSICAL EXAMINATION ON PRESENTATION : Physical examination revealed temperature was 96.9 , heart rate was 121 , blood pressure was 122/86 , respiratory rate was 22 , and oxygen saturation was 96% on room air . In general , the patient looked acutely and chronically ill . Head , eyes , ears , nose , and throat examination revealed the oropharynx was clear . Sclerae were anicteric . Mucous membranes were moist . Cardiovascular examination revealed tachycardic first heart sound and second heart sound . No murmurs , rubs , or gallops . Lungs revealed decreased breath sounds and dullness to percussion in the left lung base . The abdomen was distended and firm . Positive bowel sounds . Extremity examination revealed no clubbing , cyanosis , or edema . IMPRESSION : This was a 55 - year-old gentleman with recently diagnosed abdominal carcinomatosis admitted with increased abdominal pain and poor oral intake . The patient was admitted to the O-CMED Service for further management . HOSPITAL COURSE : The patient was admitted to the O-CMED Service . He was placed on a patient-controlled analgesia for pain control . He was administered intravenous fluids and oral diet as tolerated . On the night of 05-01 , the patient complained of increased vomiting . He also complained of increased shortness of breath and " difficulty catching his breath ." On room air , the patient 's oxygen saturation was 80% . His saturation increased to 87% on a nonrebreather . A chest x-ray disclosed a left pleural effusion . The patient was bolused with intravenous heparin due to concern for pulmonary embolism . The patient expressed a desire to be full code , so he was transferred to the Intensive Care Unit . The patient became more comfortable being seated upright with nebulizer treatments . An angiogram was done which disclosed possible subsegmental pulmonary emboli of the upper lobes as well as infiltrates consistent with aspiration pneumonia . The patient was placed on Flagyl and Levaquin for treatment of pneumonia . He was continued on heparin for treatment of the pulmonary emboli . While in the Intensive Care Unit , the patient was noted to have increasing abdominal distention . On 05-03 the patient underwent an abdominal ultrasound with paracentesis , and 5 liters of fluid were removed . On 05-04 , the patient was transferred back to the O-CMED CSRU Service . Due to persistent gastric secretions , an nasogastric tube was placed for decompression . The patient was noted to have a functional ileus . Octreotide was initiated in an attempt to decrease the gastric secretions . On 05-13 , the patient 's respiratory status declined further . He was noted not have an increasing left-sided pleural effusion . A thoracentesis was done with removal of 1.5 liters of fluid . A paracentesis was repeated with removal of 2.5 liters of fluid . On the night of 05-13 , the patient continued to decline . The family decided to pursue comfort measures . Morphine was administered to insure patient 's comfort . The patient expired at 6 p.m. on 05-14 . FINAL DISCHARGE DIAGNOSES : 1. Gastrointestinal adenocarcinoma ; primary unknown ( likely hepatobiliary ) . 2. Aspiration pneumonia . 3. Pulmonary emboli . 4. Hypoxia . 5. Dehydration . 6. Ileus . Pearl Y. Simmons , M.D. 68-957 Dictated By : Lynn J Crump , M.D. MEDQUIST36 D : 2012-05-14 19:24 T : 2012-05-19 05:00 JOB # : 79196 Signed electronically by : DR. Catherine GOLDSTEIN on : Andrea 2012-06-07 8:18 AM ( End of Report )