text: 1. GI  Patient was transfused 2 units of packed red blood cells overnight   the first night after admission and his hematocrit bumped up appropriately .', 'He remained hemodynamically stable throughout his admission . He was continued on a proton pump inhibitor and on iron sulfate and vitamin C .', 'His Coumadin was held at the time given the bleeding   even though it was important to keep his INR 2.5-3.5   given his artificial valve it was felt that the risk of continued bleeding was to', 'great to continue the Coumadin . He was subsequently seen by the GI team who performed an upper endoscopy which demonstrated the following', 'In the esophagus   there was a small hiatal hernia and in the stomach there is evidence of erosive gastritis of the body of the stomach and the antrum   the mucous appeared edematous .', 'A small polyp was found in the fundus which stigmata of old bleeding  an Endoclip was applied to this . Another polyp was found in the antrum and cold biopsies were obtained there .', 'In the duodenum   a small AVM was noted in the second portion of the duodenum and was cauterized . The biopsy subsequently demonstrated a hyperplastic polyp with acute and chronic inflammation', 'and erosion and reactive epithelial changes but no dysplasia . Also of note   prior to the upper endoscopy   the patient received fresh frozen plasma to reverse his anticoagulation .', 'Patient remained hemodynamically stable during and after the upper endoscopy and his hematocrit remained above 30 following this until the point of discharge .', 'His last recorded hematocrit on discharge was 31.3 . His last BUN and creatinine were 42 and 1.5 with an INR of 2.5 . Consideration was given to performing a repeat colonoscopy .', 'This was discussed with the GI Service who felt that this was not necessary given the recent colonoscopy that he had had in 05  2003 . 2.', 'Cardiovascular  A  Ischemia  Patient &aposs troponin bump was found to be likely to demand ischemia in the setting of his GI bleed   it was not felt that he was having acute coronary syndrome .', 'On discharge   he was continued on his aspirin   simvastatin and his Lopressor which was initially held   and subsequently restarted . B  Rhythm  Patient continued to be in A-fib.', 'throughout the admission and was restarted on his Coumadin concurrently with heparin . Heparin was subsequently DCd once his INR reached a therapeutic level between 2.5-3.5 .', 'His last reported INR on discharge was 2.5 . C  Valves  Patient had   as noted above   his anticoagulation was initially reversed despite his having artificial valves .', 'However   his Coumadin was subsequently restarted and he achieved therapeutic INR levels before discharge . D Pump  Patient   during this hospital course', 'became hypervolemic likely due to his diuretics being held and due to his receiving blood products . He was diuresed initially with one dose of Lasix and subsequently with one dose of torsemide', 'after it was discovered that he developed thrombocytopenia on a prior admission in reaction to Lasix . He subsequently was diuresed to a euvolemic state . Of note   he did not become', 'thrombocytopenic on this admission .