Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, Blood loss anaemia, Blood urea increased, COVID-19
Clinical narrative: DISCHARGE DIAGNOSES: 1- GIB 2/2 LA grade A acute esophagitis and non bleeding gastric ulcer 2- Anemia 2/2 acute blood loss 3- History of persistent A. Fib 4- History of CLL 5- Modest BUN elevation-likely multifactorial including modest dehydration/prerenal and secondary to absorption of blood from the GI tract 6- Hx of covid-19 infection now clinically cleared from covid infection  HOSPITALIST PROGRESS NOTE2/13/2022     CHIEF COMPLAINT:  Melena/GI bleed.   SUBJECTIVE: Patient is seen and examined in his room today.  He is comfortably lying in bed.  Responds commands appropriately.  Family arrived to bedside when I was there.  Discussed with him in detail about his presentation, EGD, colonoscopy results.  Also discussed about holding Lovenox with this ongoing bleeding.  They understand plan very well.  Patient denies any new symptoms or complaints.  Denies any pain.  No abdominal cramping.  We will continue to watch him closely with frequent hemoglobin checks.  He can be transferred out of ICU today.  ASSESSMENT:  81-year-old gentleman with history of recent hospitalization from 2/6/2022-2/8/2022 for COVID-19 pneumonia with background of CLL, atrial fibrillation, hypertension along with other issues presented back to hospital on 2/9/2022 with hematochezia.  Endoscopy was done there showing some nonbleeding gastric ulcers and esophagitis.  With persistent hemoglobin drop along with hypotension he got transferred here for further evaluation by GI.  Had a colonoscopy on 2/12/2022 with preparation which did not show an acute bleed.  Will need continued hospitalization for further monitoring.   PLAN: o Acute GI bleed: o Acute blood loss anemia: As mentioned above he was recently hospitalized with COVID-19 pneumonia.  He was on Lovenox for a short time and aspirin which she takes daily.  I do not see any ongoing Lovenox treatments at discharge from hospital on 2/8/2022.  He had slightly elevated D-dimer and CT chest that was negative for PE.  However he noticed melena on the day of discharge and was hospitalized on 2/9/2022.  With persistent hemoglobin downtrend and ongoing melena he got transferred here for further management. o S/p UGI endoscopy on 2/10/2022, acute esophagitis, nonbleeding gastric ulcers noted. o S/p colonoscopy on 2/13/2022: Single 3 mm sessile polyp removed, no active bleeding noted otherwise. o No clear source of bleeding at this time. o Follow hemoglobin trend every 6 hours. o Protonix 40 mg twice daily IV. o Start diet and continue as tolerated. o Hemodynamic stable, transfer out of ICU now. o If he bleeds further we will consider tagged RBC scan. o S/p 4 PRBC transfusion so far. o Recent COVID-19 pneumonia with hypoxic respiratory failure: Seems to be much better now.  Saturating well on room air.  Denies Any new symptoms.  Occasional dry cough present.  Initial positive date was on 1/26/2022.  No precautions necessary at this time. o Persistent atrial fibrillation: PTA on flecainide and metoprolol.  Continue both with holding parameters.  His Xarelto was discontinued about 6 months ago after discussions with cardiology and neurology with his problems of hematuria. o CLL: Not on medications.  Blood counts on the higher side. o History of prostate cancer: No intervention needed now. o Hypertension: Blood pressures on the lower side, PT amlodipine on hold.  Metoprolol is being continued with holding parameters.