Age: 48.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram thorax abnormal, Condition aggravated, Cough, Diaphragmatic disorder, Diaphragmatic hernia
Clinical narrative: Patient is a 49-year-old male with PMH significant for type 2 diabetes, hypertension, history of stroke presents to the hospital 11/17 with complaints of dyspnea, chest tightness, an episode of lightheadedness/presyncope, intermittently diaphoretic and ongoing ?gurgling noises? in LUQ of his abdomen since his surgery in January. In ER he was noted to be COVID positive, chest x-ray unremarkable except for air-fluid level in the left upper quadrant, labs significant for microcytic anemia.  Patient was given 1 unit PRBC for hemoglobin 6.7 and admitted for further management.  Patient denied any melena, hematochezia or hematemesis. Patient was noted to have symptomatic microcytic iron deficiency anemia with suspected low-grade chronic GI blood loss.  Hemoglobin remained stable after PRBC, 7.2 at discharge.  Patient did receive 3 doses of Ferrlecit and will need further IV dosing as outpatient through his PCP.  Recommended him to take daily oral iron as well.  GI was consulted but given covid status, without any active bleed, EGD/colonoscopy was not felt to be urgent and will need to be scheduled within the next 2 weeks.  PCP can also consider CT abdomen/pelvis if EGD/colonoscopy are negative.  Patient was given empiric Protonix. Patient complained of gurgling noises in LUQ, intermittently since his surgery January 2022, more notable after a meal.   CT thorax was obtained, showed large left diaphragmatic hernia with diaphragmatic defect measuring 69 mm in maximum diameter and contain 50% of the stomach.  Offered patient to have General surgery evaluate him here, however patient wanted to discharge in follow-up as outpatient.  Patient also stated that he does not want to see his previous surgeon again he felt that the surgeon was disinterested in his care.  Give him contact details for surgeon (was on-call for today) and requested patient to call office to arrange appointment. Patient was also noted to have scattered pulmonary nodules (largest 13 mm, previously 7 mm) that needs to be followed up with a repeat CT in 3-6  months.  (This was notified to him after he was discharged, on the phone) --- Chart reviewed  History of left-sided loculated pleural effusion/empyema--05/04/2021 Thoracentesis, followed by left thoracotomy with total decortication of the left lung 5/7/2021.  Subsequently in 09/2021, patient was noted to have a new eventration of stomach through posterior hemidiaphragm on the left.  CT of the chest without contrast  confirmed the findings.  Patient was referred to General surgery.  Surgery recommended diaphragmatic repair, patient had preop endoscopy on 11/16 which was otherwise normal.  Patient had laparoscopic repair of congenital diaphragmatic hernia on 01/06/2022. --- Patient also tested positive for COVID-19 on 11/17, with symptoms of sweats, dyspnea, cough and fever.  He did not need any therapeutics.  He would be off isolation on 11/18.   Consultations: Gastroenterology   Procedures: CT thorax--showed large left diaphragmatic hernia with diaphragmatic defect   BP 137/76  | Pulse 86  | Temp 36.9 °C (Oral)  | Resp 18  | Ht 1.829 m  | Wt 114.3 kg  | SpO2 98%  | BMI 34.17 kg/m²    Physical Exam Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed. He is not ill-appearing or toxic-appearing.  Eyes:     Pupils: Pupils are equal, round, and reactive to light.     Comments: Left eye strabismus  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds, S1 normal and S2 normal.  Pulmonary:     Effort: No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Abdominal:     General: There is no distension.     Palpations: Abdomen is soft. There is no mass.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.  Psychiatric:        Behavior: Behavior normal