Age: 90.0
Sex: F
Vaccine: COVID19
Symptoms: Haemoglobin, Haemorrhoids, Heart rate decreased, Hiatus hernia, Hypercoagulation
Clinical narrative: Date of Admission: 11/27/2023   Date of Discharge: 12/1/2023   Issues to be Addressed at Follow-up: Incidental finding of thickened endometrials trip and left adnexal strip on CT enterography, needs outpatient pelvic ultrasound   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   12/1/2023 11:27 AM SURGICAL PATHOLOGY In process --       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) GI HEMORRHAGE   ? LEFT OVARIAN CYST       Thickened endometrials trip and left adnexal strip on CT enterography, needs outpatient pelvic ultrasound   ? DIVERTICULOSIS OF COLON   ? HX OF COLONOSCOPY       - colonoscopy to TI 12/1/23 with six 2-7 mm polyps removed; moderate sigmoid diverticulosis; 2+ internal hemorrhoids; no old blood seen; no bleeding sources found   ? HIATAL HERNIA       - EGD 11/28/23 with patchy esophageal erythema (biopsies with reactive changes); mild narrowing at GE junction; 1 cm hiatal hernia   ? ACUTE UTI   ? COVID-19 DISEASE   ? ANEMIA   ? MILD COGNITIVE IMPAIRMENT OF UNKNOWN ETIOLOGY   ? ATRIAL FIBRILLATION, UNSPECIFIED W PROTHROMBOTIC STATE       On met, dig, coumadin - con't ECHO 12/10 - left ventricular ejection fraction is   estimated to be 65 to 70%, Moderately dilated left atrium Followed by Dr.    ? DM 2   ? HTN   ? HYPERLIPIDEMIA     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 92-year-old female with history of mild cognitive impairment, hypertension, hyperlipidemia, typhlitis type II, A-fib on Pradaxa presented with GI bleed Patient is s/p EGD on 11/28/2023 with no bleeding lesion identified, hemoglobin continue to be stable, underwent colonoscopy 12/1/2023 without active bleeding, polypectomy done, per GI okay to resume Pradaxa on 12/4/2023 Patient had a CT enterography per GI which did not show any obvious reason for GI bleed Patient had a thickened endometrials trip and left adnexal strip on CT enterography, needs outpatient pelvic ultrasound Patient on Pradaxa for A-fib per GI okay to resume on 12/4/2023 as currently ordered.  Risk-benefit was discussed with the patient's daughter, daughters would like to resume patient's anticoagulation to see if she is able to tolerate   Primary Procedures:    EDG Impression 11/28/2023:  No signs of recent or active GI bleeding. Esophagus: -GE junction at 40 CM with mild narrowing.  Able to pass GIF 190 into the stomach with mild resistence. -patchy erythema throughout, biopsies obtained. -1 cm hiatal hernia Stomach: -normal mucosa, no bleeding or other mucosal lesions identified. -GE junction/carida: normal in retroflexion.  Duodenum: bulb and 2nd portion normal  -no bleeding lesions identified.  Overall no significant UGI pathology.  Bleeding may be from lower small bowel or right colon source.    Colonoscopy Impression 12/1/2023:  1. Six 2-7 mm colon polyps removed 2. Moderate sigmoid diverticulosis 3. 2+ internal hemorrhoids 4. Fair prep only, fair to good exam done after washing 5. Otherwise normal colonoscopy to the TI with no old blood in the colon 6. Repeated vasovagal episodes with any colon distension with HR dropping to the low 40s.  Exam somewhat limited as optimal colon distension not done due to repeated vasovagal episodes. 7. Overall, no cause of anemia found on colonoscopy Recommendations:  1. Clears, advance diet as tolerated 2. Await pathology 3. CT enterography     Secondary Procedures: CT ABD PELVIS: Patient Communication     Add Comments   Seen    Impression  Normal CT enterography.      Small jejunal diverticulum present    Colonic diverticulosis without radiographic evidence of diverticulitis.    Thickened endometrial stripe with left adnexal cyst and fluid seen in the perirectal space is present suggesting pelvic disease. Recommend pelvic ultrasound for further evaluation.    Small bilateral lower lobe pleural effusions and consolidations.    1.3 cm pancreatic cyst noted in the head. For asymptomatic patients, imaging follow up can be performed with pancreas protocol MRI/MRCP or pancreas protocol CT in 2 years. Of note, the decision to follow lesions in this age group should be made in conjunction with the patient's overall health status and preferences.  Consider GI referral for symptomatic patients. (#pan1b)     Reason for Hospital Admission (Admitting Diagnosis):  GI bleed   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. GASTROENTEROLOGY - ONGOING INPATIENT CONSULTATION. PALLIATIVE CARE - INITIAL INPATIENT CONSULTATION. PALLIATIVE CARE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: DNR      Note Details  Author (M.D.) File Time 12/2/2023 11:25 AM Author Type Physician Status Addendum Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 11/27/2023  ED to Hosp-Admission (Discharged) on 11/27/2023  ED to Hosp-Admission (Discharged) on 11/27/2023   Revision History   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders Procedures   Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Linked Episodes  ESOPHAGOGASTRODUODENOSCO From 11/28/2023 to 11/29/2023 COLONOSCOPY DIAGNOSTIC From 12/1/2023 to 12/2/2023  Hospital Problem List   HYPERLIPIDEMIA  HTN  DM 2  ATRIAL FIBRILLATION, UNSPECIFIED W PROTHROMBOTIC STATE  MILD COGNITIVE IMPAIRMENT OF UNKNOWN ETIOLOGY  GI HEMORRHAGE  COVID-19 DISEASE  ANEMIA  ACUTE UTI  DIVERTICULOSIS OF COLON  HX OF COLONOSCOPY  HIATAL HERNIA  LEFT OVARIAN CYST Care Timeline  11/27   Admitted from ED (Observation) 1653 11/28   ESOPHAGOGASTRODUODENOSCOPY 12/01   COLONOSCOPY DIAGNOSTIC 12/02   Discharged 1430  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 12/2/2023) Medication List at Discharge   cefpodoxime proxetil 200 mg Oral EVERY 12 HOURS  dabigatran etexilate mesylate 150 mg Oral 2 TIMES A DAY  escitalopram oxalate 15 mg Oral DAILY  furosemide 20 mg Oral 2 TIMES A DAY  hydrocortisone 2.5 % Apply to affected area(s) 2 times a day as needed for rash . OK to use on face, neck or skin folds. Avoid long-term use near eyes. Stop when rash is gone  lovastatin 40 mg Oral DAILY, after dinner/supper for cholesterol  multivitamin/iron/folic acid 18-400 mg-mcg 1 tablet Oral DAILY  pantoprazole sodium 40 mg Oral DAILY