Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Colon cancer metastatic, Computerised tomogram abdomen abnormal, Computerised tomogram kidney abnormal
Clinical narrative: Patient is a 69 y.o. female patient of MD residing in extended care facility with history of hypertension hyperlipidemia diabetes mellitus, and is known for bipolar depressive disorder also anemia of iron deficiency and Parkinson's disease is here due to alteration mental status and reported COVID-positive noted to be borderline hypoxic at 88% at room air was admitted for further management CAT scan of the brain showed no acute findings and chest x-ray on arrival was negative for any infiltrates, poor historian on arrival to the emergency department    COVID-19 respiratory infection Acute hypoxic respiratory failure Overall stable vital signs requiring oxygen by nasal cannula  Chest x-ray reviewed showed no infiltrates CTPA reviewed with no pulmonary emboli.  Showed bilateral lung infiltrates versus atelectasis.  Also, some groundglass opacities and consolidative opacities. Check on inflammatory markers.  CRP 123 on presentation ID consult.  ID has been following.  Patient was treated with steroids and remdesivir during hospitalization.  Will continue oral steroids on discharge   Colon cancer with liver metastasis POA  CTPA showed multiple new liver lesions concerning for metastatic disease.  CT abdomen pelvis showed 6 cm sigmoid colon mass with moderate to significant narrowing of the sigmoid lumen.  There is proximal dilation of the large bowel with moderate amount of stool. CTA 1,179 Last colonoscopy 11-2019 large polyp removed from ascending colon at facility, resulted in perforated colon for which she underwent right hemicolectomy with primary anastomosis with Dr.  The  pathology of the polyp is not available to us at this time. Discussed the findings with the Guardian. She is the patient's daughter. Consulted general surgery and oncology.  General surgery evaluated patient.  The patient will need colonoscopy.  This should be done in the near future given that she has an acute infection with COVID.  Surgery signed off.     IR consulted for liver biopsy.  IR decided to do the procedure after recovery from COVID as outpatient.  This will need to be followed up Per heme-onc, workup to be done as outpatient, will need close follow-up for this.  Discussed with case management on day of discharge for helping expedite this and setting up appointment   Acute metabolic encephalopathy POA improved Likely related to the infection, CAT scan of the brain reviewed and showed no acute findings Neurochecks   Right hydronephrosis CT PE showed increasing right hydronephrosis Kidney functions within normal Outpatient follow-up Hypertension Continue lisinopril and metoprolol   Diabetes mellitus  Lantus at lower dose while in hospital. Was on 38 units started recently at SNF. Sliding scale insulin, Januvia, and metformin Hold glipizide Hemoglobin A1c 7.4   Hyperlipidemia  on statin therapy   Pulmonary nodule 6 mm nodule in the left upper lobe Outpatient follow-up   Goiter CTPA showed heterogenous nodular thyroid which may reflect goiter TSH within normal Outpatient follow-up