Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Lung opacity, Nausea, Oesophageal oedema, Pain, Pneumonia
Clinical narrative: 60 year old female with a history of lung cancer, SBO came to the ER with abdominal pain.  She states it started suddenly Saturday morning.  She felt like her abd gets more distended and she will try to burp or throw up but can not.  When she has a NG tube placed generally it resolves quickly.  Today however it did not.  A CXR did show a new left lobe infiltrate was noted so she was placed on IV antibiotics.  DISCHARGE DIAGNOSES:  1. Abdominal pain related to impaired motility likely due to her methadone and intermittent high residue diet 2. COVID-19 pneumonia 3. Chronic pain 4. Hypertension related to opioid withdrawal   HOSPITAL COURSE: 60-year-old woman with a past medical history of right breast cancer stage III, H ER 2 positive, ER + 1/26/2004, metastatic breast cancer in the liver 12/2005, stage Ia TTF-1 positive NSCLC w/  left upper lobe 10/31/2019 with a left upper lobectomy small cell lung cancer, recurrent SBO's, history of esophageal dilitation who is presenting w/ abd pain and distention, delayed gastric emptying, continued reflux  and now a possible new pneu LLL   Abdominal pain related to impaired motility likely related to her methadone and intermittent high residue diet: Abdominal pain with frequent reflux and belching associated with nausea had continued prior to admission Initially was felt she had a SBO vs gastric outlet obstruction. NG had been placed with improvement of her symptoms, she actually was able to have some belching with the NG in place General surgery was consulted, did not feel there was any indication for surgical intervention at this time, she has had improvement with her NG (which typically resolves her symptoms) with her prior SBO versus gastric outlet obstruction. General surgery recommending GI consult for consideration of an EGD to reevaluate the stomach and its outlet GI consult felt that she had impaired motility related to her methadone and oxycodone along with high intermittent residue diet.  Recommendations for Reglan 5 mg IV every 6 hours x3, which did not offer any relief.  She continued w/  n.p.o., slowly transition to clear liquid diet the day prior to discharge and on the day of discharge she is tolerating a soft diet in nature small in quantity. During her hospitalization she did use very little of her routine methadone and oxycodone due to her n.p.o. status.  She tolerated this well until approximately 2-1/2 days prior to discharge when she was having hypertension likely related to withdrawal symptoms from her methadone.  Her methadone was restarted but her oxycodone has been stopped. Discussed with patient to try to not resume her oxycodone and see her pain management team to continue titrating off methadone. She will need follow-up as an outpatient in the GI clinic and encouraged and praised her doing so well with her limited narcotics and advised her to to reduce narcotics as able   COVID-19 pneumonia: CT demonstrated patchy peripheral groundglass opacities within the lingula and left lower lobe concerning for infectious versus inflammatory process Was initially felt to be pneumonia and was started on azithromycin and ceftriaxone Procalcitonin came back 0.04?not indicative of antibiotics Patient has remained on room air Plan:  o Avoided IV fluid resuscitation due to inflammation with COVID o Push p.o. H2O o Patient was not on O2 so no need for steroids     Chronic pain: Patient currently on IV Dilaudid for pain control as is n.p.o. unable to take her p.o. methadone and oxycodone. Does not appear she has been using any Dilaudid thus far Plan:  o Again per GI recommendations try to avoid further narcotic use - acutally was having HTN and likely related to w/d from her long term use of Methadone/oxy.  o Restart Methadone as should be slowly tapered off vs stopping abruptly -patient to follow-up with her pain team o Did point out to patient that she has not had any oxycodone that she may wish to discontinue at her discharge     TEST/PROCEDURES DONE THIS ADMISSION:  1/9/2022 Imaging: