Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Biopsy oesophagus, Blood creatinine normal, COVID-19, Cough, Haematemesis
Clinical narrative: This is a 78 yo male who presented to the ED with c/o of hematemesis.  He has a PMHx of HTN and HLPD.  History obtained from patient.  Patient states that he has been in his normal health until this past week.  His wife tested positive for COVID 19 with upper respiratory sx last week.  He had some mild sinus congestion and slight cough so he tested positive at home 1/11.  Since then his symptoms have resolved.  He has been using a nightly Alka-Seltzer cold, but otherwise denies any heavy NSAID use.  Since his diagnosis he has been doing a nightly hot toddy but usually does not consume alcohol.  He reports that last night around 11pm he started to feel weak, nauseated, and pain between his shoulder blades.  This continued until about 5am when he "spat up" blood.  He reports that he does not vomit he has never been able to.  But does recall dry heaving prior to the event.  He denies any epigastric discomfort, chest pain, heart palpitations, melena, diarrhea, abdominal pain, fever.  He has never had a GI bleed.  Last colonoscopy was about 5 years ago and normal, never had an EGD.  He was started on PPI gtt in the ED.  Lab work fairly unremarkable (Scr 1.2 but no priors for comparison), Hgb stable 14.  HR sinus tachycardia 110-120s, BP stable.  GI consulted.  Hospital medicine asked for admission.   01182022: Pt. is a 70-year-old man with history of hypertension, hyperlipidemia, and AAA s/p repair who presented to the ED with hematemesis.      Patient had developed upper respiratory symptoms and tested positive for COVID-19 at home on 1/11.  His upper respiratory symptoms quickly resolved.  On the evening prior to admission, patient had developed some weakness and nausea. Later on the next morning he had an episode of hematemesis.  Due to these symptoms, patient presented to the ED for further evaluation.      Upon arrival to the ED, Patient was noted to have relatively stable vital signs except for mild tachycardia to the 110's - 120s.  Admission lab work was largely unremarkable (hemoglobin 14).  Patient was started on IV Protonix infusion.  GI was consulted.  Hospitalist was then contacted for admission.    GI was consulted and patient underwent EGD on 1/17.  EGD was concerning for grade D esophagitis with long segment of Barrett's esophagus.  There was some active bleeding from some areas of esophagitis that underwent cautery.  Biopsies were taken of esophagus to further evaluate esophagitis and areas of Barrett's.  Patient was monitored following EGD and had no further episodes of hematemesis or melena.  His hemoglobin remained stable around 11.  Patient reported significant improvement in his abdominal pain/nausea.  Patient was switched over to PO PPI BID and Carafate slurries.  Patient will follow-up with GI in outpatient setting.  He will need to have repeat EGD in 2 months to ensure that esophagitis is continuing to improve and to further evaluate Barrett's esophagus.  Patient was discharged home with plans to follow up closely with his PCP and with GI in outpatient setting.    Regarding his COVID diagnosis, patient did not have any symptoms consistent with COVID infection during this admission.  Patient should be finished with his COVID isolation as it has been greater than 5 days since he tested positive and his symptoms continue to improve.  He was instructed to continue to wear mask until at least 10 days following his positive test.