Volvulus Depressive disorder not elsewhere classified Essential and other specified forms of tremor Other left bundle branch block Paralytic ileus
 
Name:  ___                Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: SURGERY
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___.
 
Chief Complaint:
abdominal pain
 
Major Surgical or Invasive Procedure:
___ R hemi-colectomy 

 
History of Present Illness:
HPI:  ___ with reported history of redundant colon and
conservatively-managed sigmoid volvulus presents with acute 
onset
abdominal pain and nausea. Ms ___ awoke at 0200 this morning
with sharp low abdominal pain that came in waves. She developed
nausea and chills and had one episode of non-bloody diarrhea. 
She presented to the ___ ED where she proceeded to have an
episode of nonbloody, nonbilious emesis.  CT A/P revealed cecal
volvulus, for which a surgical consult is requested.

Upon interviewing Ms ___, she reports her pain to now be
constant and located in the RLQ. She endorses nausea but denies
any further emesis. She additionally denies fevers, hematemesis,
hematochezia. She has not passed flatus since the onset of her
pain.

 
Past Medical History:
Past Medical History:
1. Reports hx of sigmoid volvulus treated conservatively with
bowel rest/NGT. 
2. Hx chronic abdominal discomfort followed by ___
gastroenterologist. Pt reports numerous tests performed without
definite etiology.
3. Depression
4. Essential tremor
5. Hx b/l varicose veins

 
Social History:
___
Family History:
NC
 
Physical Exam:
Physical Exam: upon admission ___:

Vitals: T 97.7,  Hr 85,  BP 166/83,  RR 18,  O2Sat 100% RA
GEN: Thin woman in NAD. Alert and oriented.
HEENT: No scleral icterus. Mucus membranes dry.
CV: RRR
PULM: Clear to auscultation b/l
ABD: Soft, minimally distended. Tender RLQ and infraumbilical
area. Prominence over LUQ which is nontender. No R/G.
Ext: Warm without edema.

 
Pertinent Results:
___ 05:30AM BLOOD WBC-7.0 RBC-3.92* Hgb-11.2* Hct-34.6* 
MCV-88 MCH-28.5 MCHC-32.3 RDW-13.6 Plt ___
___ 05:25AM BLOOD WBC-8.3 RBC-4.59 Hgb-12.7 Hct-40.3 MCV-88 
MCH-27.6 MCHC-31.5 RDW-13.3 Plt ___
___ 05:25AM BLOOD Neuts-86.0* Lymphs-10.9* Monos-2.4 
Eos-0.3 Baso-0.4
___ 05:30AM BLOOD Plt ___
___ 05:25AM BLOOD Plt ___
___ 05:25AM BLOOD Glucose-113* UreaN-6 Creat-0.8 Na-140 
K-3.6 Cl-103 HCO3-30 AnGap-11
___ 06:30AM BLOOD Glucose-121* UreaN-6 Creat-0.7 Na-139 
K-3.7 Cl-101 HCO3-32 AnGap-10
___ 05:25AM BLOOD Calcium-9.1 Phos-2.9 Mg-1.8
___ 06:30AM BLOOD Calcium-8.8 Phos-2.4* Mg-1.8

EKG: ___:

Sinus rhythm. Left bundle-branch block. Non-specific septal T 
wave changes. No previous tracing available for comparison. 
Tracing #1  
EKG: ___:  

 Sinus rhythm. Left bundle-branch block. Compared to tracing #1 
no change. 
TRACING #2 

___:  cat scan of abdomen and pelvis:

IMPRESSION: 
1. Cecal volvulus with closed loop obstruction. 
  
2. Multiple hypodensities within the liver, the largest of which 
are 
compatible with cysts. Others are too small to characterize but 
are 
statistically likely to represent cysts. 

___:  x-ray of the abdomen:

IMPRESSION: Ileus or early obstruction. Followup is recommended. 

  

  

  
 

 
Brief Hospital Course:
___ year old female admitted to the acute care service with 
abdominal pain and nausea.  Upon admission, she was made NPO, 
given intravenous fluids, and underwent a cat scan of the 
abdomen which showed a cecal volvulus. She was placed on 
intravenous antibiotics.  On HD #1, she was taken to the 
operating room where she underwent a 
right colectomy with primary anastomosis. Her operative course 
was stable with minimal blood loss.  She was extubated after the 
procedure and monitored in the recovery room.  

Her post-operative course has been stable. Her surgical pain was 
controlled with intravenous analgesia. She was started on sips 
on POD # 1 and her pain regimen was converted to oral analgesia. 
Her bowel function was slow to return and she underwent an x-ray 
of the abdomen which showed a ileus vs obstruction.  She was 
given a dose of methynaltrexone.  On POD #5, she began passing 
flatus and her diet was advanced. She resumed her home meds.

Her vital signs are stable and she is afebile.  She is 
tolerating a regular diet.  Her white blood cell count is 7.0 
with a hematocrit of 35.  She has been ambulating.  She is 
preparing for discharge home with follow-up in the acute care 
clinic for staple removal.  She has also been advised to follow 
up with her primary care physician to further evaluate the 
finding of left bundle ___ block on recent EKG. 

 
Medications on Admission:
___: Citalopram 10; Clonazepam 0.5 HS 
 
Discharge Medications:
1. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a 
day (at bedtime)).  
2. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).  
3. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID 
(2 times a day).  
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
times a day).  
5. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 
hours) as needed for pain: may cause drowsiness, avoid driving 
while on this medication.
Disp:*30 Tablet(s)* Refills:*0*
6. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 
hours).  

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
sigmoid volvulus

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

 
Discharge Instructions:
You were admitted to the hosptial with abdominal pain.  You had 
a cat scan of your abdomen done which showed a twising of the 
colon.  This can lead to a bowel obstruction.  You were taken to 
the operating room where you had a segment of your colon 
removed. You have made a nice recovery and you are ready for 
discharge home with the following instructions:

Please call your doctor or return to the emergency room if you 
have any of the following:
 

 * You experience new chest pain, pressure, squeezing or 
 tightness.
 
* New or worsening cough or wheezing.
 
* If you are vomiting and cannot keep in fluids or your 
 medications.
 
* You are getting dehydrated due to continued vomiting, 
 diarrhea or other reasons. Signs of dehydration include dry 
 mouth, rapid heartbeat or feeling dizzy or faint when standing.
 
* You see blood or dark/black material when you vomit or have a 
 bowel movement.
 

* You have shaking chills, or a fever greater than 101.5 (F) 
 degrees or 38(C) degrees.
 
* Any serious change in your symptoms, or any new symptoms that 
 concern you. 
 
* Please resume all regular home medications and take any new 
meds 
 as ordered.  

Activity:
No heavy lifting of items ___ pounds for 6 weeks. You may 
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming. 

If there is clear drainage from your incisions, cover with 
clean, dry gauze. 

You will need to follow-up in the acute care clinic for removal 
of your staples.
 
Followup Instructions:
___

{'abdominal pain': ['Volvulus'], 'nausea': ['Volvulus'], 'chills': ['Volvulus'], 'diarrhea': ['Volvulus'], 'constipation': ['Paralytic ileus'], 'tremor': ['Essential and other specified forms of tremor'], 'depression': ['Depressive disorder'], 'left bundle branch block': ['Other left bundle branch block']}