638157550 SC
97308722
6261929
1/22/2005 12:00:00 AM
gastritis
DIS
Admission Date :
01/22/2005
Report Status :
Discharge Date :
01/24/2005
****** DISCHARGE ORDERS ******
AKOTE , NAO 630-65-64-5 Q39
Room :
70B-157
Service :
GGI
DISCHARGE PATIENT ON :
01/24/05 AT 07:00 PM
CONTINGENT UPON
Not Applicable
WILL D / C ORDER BE USED AS THE D / C SUMMARY :
YES
Attending :
GAETZFREIERM , DENA DA , M.D.
CODE STATUS :
Full code
DISPOSITION :
Home
DISCHARGE MEDICATIONS :
AMOXICILLIN 1,000 MG PO BID X 28 doses
Instructions :
for H.Pylori .
Food / Drug Interaction Instruction
May be taken without regard to meals
CLARITHROMYCIN 500 MG PO BID X 28 doses
Instructions :
h.pylori tx .
Food / Drug Interaction Instruction
Take with food
Alert overridden :
Override added on 01/23/05 by DAINSAYLESNOORT , AGER , M.D. , PH.D.
SERIOUS INTERACTION :
SIMVASTATIN and CLARITHROMYCIN
POTENTIALLY SERIOUS INTERACTION :
SIMVASTATIN and CLARITHROMYCIN
Reason for override :
will monitor .
HYDROCHLOROTHIAZIDE 25 MG PO QD ZOCOR ( SIMVASTATIN ) 40 MG PO QHS
Food / Drug Interaction Instruction
Avoid grapefruit unless MD instructs otherwise .
Override Notice :
Override added on 01/23/05 by DAINSAYLESNOORT , AGER , M.D. , PH.D. on order for CLARITHROMYCIN PO ( ref # 99052380 )
SERIOUS INTERACTION :
SIMVASTATIN and CLARITHROMYCIN
POTENTIALLY SERIOUS INTERACTION :
SIMVASTATIN and CLARITHROMYCIN
Reason for override :
will monitor .
POTASSIUM CHLORIDE SLOW REL. ( KCL SLOW RELEASE ) 40 MEQ PO QD As per SC
Potassium Chloride Policy :
each 20 mEq dose to be given with 4 oz of fluid COZAAR ( LOSARTAN ) 50 MG PO QD
Number of Doses Required ( approximate ) :
2
LAMICTAL ( LAMOTRIGINE ) 150 MG PO BID
Number of Doses Required ( approximate ) :
5
WELLBUTRIN SR ( BUPROPION HCL SUSTAINED RELEASE ) 200 MG PO BID
Number of Doses Required ( approximate ) :
4
ESOMEPRAZOLE 20 MG PO BID X 28 doses
Instructions :
H. Pylori tx .
DIET :
No Restrictions
ACTIVITY :
Resume regular exercise
FOLLOW UP APPOINTMENT ( S ) :
Dr. Gaetzfreierm 1-2 weeks ,
ALLERGY :
PERCOCET , IV Contrast , LISINOPRIL , ATENOLOL
ADMIT DIAGNOSIS :
Gastritis
PRINCIPAL DISCHARGE DIAGNOSIS ; Responsible After Study for Causing Admission ) gastritis
OTHER DIAGNOSIS ; Conditions , Infections , Complications , affecting Treatment / Stay Obesity HTN High Cholesterol Tobacco Fhx of CAD ETT 12/94 ( - ) ischemia ECHO 02/89 nl ETT 03/89 , 07/90 c / w ND ische
Takes hubby 's sl ntg Barium Swallow 04/89 ( - ) UGI 06/91 ( - )
OPERATIONS AND PROCEDURES :
OTHER TREATMENTS / PROCEDURES ( NOT IN O.R. )
MRI HIDA CT
BRIEF RESUME OF HOSPITAL COURSE :
The pt is a 55yo F s / p Roux en Y GBP in 12/20 presenting to the ED this AM c / o mod severe midepigastric pain .
She notes that she has had this pain since Thursday , and that it becomes much worse within 15 min of consuming a meal .
She has also had intermittent post-prandial nausea / satiety for which she had been scheduled for an outpt EGD with GI on 2/8 .
She describes the pain as band-like / radiating to both sides but not the back .
Her pain currently is 5/10 .
ROS ( - ) emesis / BRBPR/melena / fever/chills / sob .
Pt was seen by GI on 13 EGD was performed HD2 which was negative for gastritis , stricture or ulcer .
Pt was found to be H. Pylori positive and therefore was started on empiric treatment .
Afferent limb of the roux en y anastamosis was visualized however the efferent limb could not be explored .
Pt had HIDA scan which was negative for obstruction , and CT was unremarkable .
Pt was tolerating regular diet by HD4 , and GI felt that further workup could be continued as an outpatient .
Pt was therefore discharged home in stable condition , voiding , ambulating and eating without difficulty .
Plans to follow up with outpatient MRA to rule out ischemic causes of post prandial pain , as well as HIDA with CK challenge to evaluate for biliary dyskinesia without stasis .
Pt will finish course of H. pylori treatment as well .
ADDITIONAL COMMENTS :
If fevers , chills , nausea , vomiting , diarrhea , increasing pain with food please call Dr. Gaetzfreierm 's office or PCP .
If severe , then proceed to ER for evaluation .
Will need to call for outpatient MRA and HIDA with CCK challenge to evaluate biliary system and mesenteric vasculature .
Please continue taking the antibiotics for H. Pylori for full course ( 26 more days ) .
DISCHARGE CONDITION :
Stable
TO DO / PLAN :
No dictated summary
ENTERED BY :
DOUETSHUFF , DE CLEEE , M.D. ( CP85 ) 01/24/05 06:53 PM
****** END OF DISCHARGE ORDERS ******