Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Liver function test normal, Malnutrition, Metabolic disorder, Metastases to peritoneum, Nitrite urine present
Clinical narrative: Patient is a 84 y.o. male patient, MD insert to Medical Center with difficulty swallowing foods and recent diagnosis of bladder cancer.   Dysphagia  Esophageal Strictures Ongoing difficulty swallowing both food, meds and liquids with Sensation of food and liquids getting stuck in his throat. Recent admission for same, reports no improvement since treatment EGD from 08/28/23 showing stenosis of distal esophagus status post dilation x2. Transferred to MC for GI evaluation - consulted GI ordered ST consult for MBS (just seen by ST last admission and thought esophageal etiology) followed by Barium esophagram ST chopped/thin; 2-3 Barium Esophagram 9/14 Tertiary contractions with a questionable stricture involving the distal esophagus, which could be secondary to tertiary contractions with underlying mass not excluded No longer taking linzess since august Started chopped/thin diet. Changed meds to po Pt still reports globus sensation and not eating S/p EGD 9/18 - severe esophageal stenosis at 29 cm, dilated with 12 to 15 mm balloon  GI consulted - PPI, repeat EGD with further dilatation in 8 weeks.  If symptoms return, then follow up with thoracic surgery for possible stent Tolerating diet    AKI 9/11 Cr 2.08, secondary to poor po intake/prerenal Baseline ~ 1.1 Creatinine trending down 1.62, stable  Encourage oral intake, IVF stopped 9/19 Nephrology consulted  Discussed with urology and Nephrology, outpatient follow with repeat renal function panel next week.  If no improvement or worsens, consider right ureteral stent.     UTI 100.2 9/17 +urinary frequency  CXR negative  UA +small leuk, WBC 17, rare bacteria  urine culture no growth received ceftriaxone in the hospital.  Discharged on Omnicef to complete 5 days    Monitor  Covid-19 Virus Infection Date of onset of symptoms: 9/17 Symptoms present on admission: fever, cough Date of covid positive test: 9/20 Vaccination status: vaccinated Imaging: CXR - negative  Oxygen requirements on admission: RA Current oxygen requirements: 2 Medical therapy: steroids.  Discharged on decadron to complete 10 days Anticipated special isolation end date: 9/22   Generalized weakness Malnutrition FTT No focal neurologic deficits. Likely multifactorial ( malnutrition, dehydration AKI, deconditioning).  Dietician consulted Unremarkable TSH, LFT, B12/folate, phos, mag A1c 5.6 PT/OT consulted - 2-3  Encourage oral intake    Urothelial carcinoma with peritoneal meds  Intermittent hematuria Also compatible with lung primary - onc evaluating Diagnosed with cystoscopy on 08/31/23. Associated with peritoneal carcinomatosis. Status post TURBT on 09/05/23 Pathology poorly differentiated carcinoma. Patient supposed to see oncology team in 2 days Oncology consulted - PET outpatient, Tempus ordered Final treatment plan outpatient once this data obtained, onc spoke to patient and family Patient/wife requested urology consult as postop appt scheduled 9/18   Abnormal urinalysis Urinalysis positive for nitrite, leukocyte esterase, WBCs. In setting of recent TURBT ( 09/05/23). Afebrile, no leukocytosis. Denied dysuria or suprapubic pain IV ciprofloxacin started at outside facility, discontinued 9/13 as not clinically consistent with UTI Urine culture negative.   Elevated troponin Troponin elevated at outside facility, but flat (84 and 71). In setting of AKI, dehydration, metabolic derangements Per records, chronic, elevated. No chest pain or shortness of breath on presentation. Hemodynamically stable. EKG unchanged from previous. Echocardiogram from 08/2023 with a normal systolic function (EF of 65%) and no significant valvular abnormalities. No further evaluation   COPD No exacerbation On RA, dulera, nebs prn, pulm toilet, nebs prn (on albuterol and Brezti at home)   Essential HTN Blood pressure still elevated  Increased norvasc to 10mg po daily    Chronic Anemia - normocytic anemia Iron Deficient and ANemia of chronic disease Hgb 10.5 on admission Baseline about 11 Onc consulted, ordered iron given intermittent hematuria Venofer ordered x2 9/14, last dose 9/15 - start oral iron when able to better take po