Cirrhosis of liver without mention of alcohol Esophageal varices in diseases classified elsewhere with bleeding Congenital factor VIII disorder Asymptomatic human immunodeficiency virus [HIV] infection status Chronic hepatitis C without mention of hepatic coma Other and unspecified hyperlipidemia Anomalous atrioventricular excitation
 
Name:  ___                     Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   M
 
Service: MEDICINE
 
Allergies: 
Penicillins
 
Attending: ___.
 
Chief Complaint:
black stools
 
Major Surgical or Invasive Procedure:
EGD
 
History of Present Illness:
Mr. ___ is a ___ yo M with PMH of HIV, hemophilia, HepC 
cirrhosis with varices, s/p bleeding episode about one month 
prior which required banding who presents with complaint of 
black stools since the morning of admission. States black stools 
began this morning, but had not been present the day prior. He 
denies any N/V, lightheadedness or chest paoin. Gave himself 2 
vials of Factor 7 and presented to the ED. Upon ED arrival, VS 
97.8, 126/74, 87, 14 and 99 on RA. Benign exam except guaiac 
positive brown stools. He was given Protonix 40mg IV, octreotide 
bolus, Cipro 400mg IV and Zofran 4mg IV x 1. Liver was consulted 
and recommened ICU admission for EGD. Upon transfer, HR ___, 
126/80, 23, 96/RA.  
.  
Upon admission, patient confirms story as above. States he has 
not been taking his home PPI since leaving ___ one week prior. 
No abdominal pain. In ___ had hematemesis then banded. Has 
been admitted one other time with black stools. He had an EGD 
but not colonoscopy at that time. No obvious source was ever 
found.  

 
Past Medical History:
1. Hemophilia. 
2. HIV- Dx ___ contracted from clotting factor; ___ VL 51 and 
CD4 264
3. HCV- Dx ___ treated with pegylated interferon and ribavirin 
for three months, stopped early due to failure to achieve any 
viral response and anemia; now on maintenance pegasysis 
4. WPW tachycardia. 
5. Hypertriglyceridemia. 
 
Social History:
___
Family History:
His brother died of complications of hemophilia 
in ___. He died from HCV. No other family history of lymphoma 
or malignancies. 

 
Physical Exam:
BP: 106/68 HR: 87 RR: 18 O2 97% RA  
Gen: Pleasant, well appearing male.  
HEENT: Mild conjunctival pallor. No icterus. MMM. OP clear.  
NECK: Supple, No LAD, No JVD. No thyromegaly.  
CV: RRR. nl S1, S2. No murmurs, rubs ___  
LUNGS: CTAB, good BS ___, No W/R/C  
ABD: Soft, NT, ND. NL BS. No HSM  
EXT: WWP, NO CCE. 2+ DP pulses ___  
SKIN: No rashes/lesions, ecchymoses. Pigmentation changes 
extensively on face.  
NEURO: A&Ox3. Appropriate. CN ___ grossly intact. Gait 
assessment deferred  
PSYCH: Listens and responds to questions appropriately, pleasant 
 

 
Pertinent Results:
___ EGD
4 bands were seen in the lower esophagus. The lower band had 
fell off, the base of which was ulcerated with no active 
bleeding.   
Impression: Abnormal mucosa in the esophagus
Otherwise normal EGD to third part of the duodenum 

___ 04:33AM BLOOD WBC-4.4 RBC-2.64* Hgb-10.7* Hct-28.9* 
MCV-109* MCH-40.6* MCHC-37.2* RDW-13.1 Plt ___
___ 11:01PM BLOOD Hct-30.3*
___ 04:56PM BLOOD Hct-31.6*
___ 11:20AM BLOOD WBC-3.9* RBC-3.29* Hgb-12.8* Hct-36.1* 
MCV-110* MCH-38.9* MCHC-35.5* RDW-13.3 Plt ___
___ 11:20AM BLOOD Plt ___
___ 04:33AM BLOOD Plt ___
___ 11:20AM BLOOD ___ PTT-51.2* ___
___ 04:33AM BLOOD ___ PTT-63.5* ___
___ 11:20AM BLOOD Glucose-110* UreaN-24* Creat-0.6 Na-138 
K-4.4 Cl-107 HCO3-24 AnGap-11
___ 04:33AM BLOOD Glucose-102 UreaN-21* Creat-0.6 Na-135 
K-4.0 Cl-107 HCO3-26 AnGap-6*
___ 11:20AM BLOOD ALT-47* AST-63* AlkPhos-63 TotBili-2.5*
___ 04:33AM BLOOD ALT-49* AST-91* AlkPhos-50 TotBili-3.0*
___ 11:20AM BLOOD Albumin-3.7 Calcium-8.3* Phos-2.4* Mg-1.8
___ 04:33AM BLOOD Calcium-7.7* Phos-2.9 Mg-1.8
___ 11:20AM BLOOD VitB12-616 Folate-10.6
 
Brief Hospital Course:
This is a ___ year old gentleman HIV, HepC, hemophilia who 
presented with black stools that began the morning of admission. 
 
.  
# GIB: Had a variceal bleed one month prior to admission while 
in ___ and had his varices banded. Had EGD on admission which 
showed that one of the bands had prematurely dropped off and 
this was believed to be the culprit though no active bleeding 
was seen at the site. Remained hemodynamically stable throughout 
admission. Started on octreotide drip for 24 hours and 
discharged on ciprofloxacin 250mg PO BID prophylactically per 
the liver service. Patient d/c on H2 blocker instead of PPI b/c 
of interaction w/HAART medications. 
.  
# HIV: HIV-1 Viral Load/Ultrasensitive (Final ___ than 
48 copies/ml. Followed by Dr. ___.  Continued HAART therapy, 
but consulted w/ ID regarding how to dose atazanavir while on 
acid suppression.  Continued Bactrim prophylaxix.  
.  
# HCV: Followed by ___. Currently on Pegasus with ___ 
dosing.  
.  
# WPW: Not on any cardiac medications. No e/o arrythmia during 
this admission.
.
# Hemophilia: Patient not followed for some time. Factor VIII 
given, Factor VIII level and Antibody level drawn. Seen by 
Hematology, to f/u in clinic. 
.  
Was listed as full code.
 
Medications on Admission:
Prilosec 20mg po daily  
Atazanavir 300 mg PO DAILY  
Peginterferon Alfa-2a 90 mcg SC 1X/WEEK (FR)  
RiTONAvir 100 mg PO DAILY  
Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY  
Sulfameth/Trimethoprim SS 1 TAB PO DAILY  
Octreotide Acetate 50 mcg/hr IV DRIP INFUSION  
Zidovudine 300 mg PO BID  

 
Discharge Medications:
1. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY 
(Daily).  
2. Atazanavir 150 mg Capsule Sig: Two (2) Capsule PO DAILY 
(Daily).  
3. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet 
PO DAILY (Daily).  
4. Zidovudine 100 mg Capsule Sig: Three (3) Capsule PO BID (2 
times a day).  
5. Peginterferon Alfa-2a 180 mcg/mL Solution Sig: Ninety (90) 
mcg Subcutaneous 1X/WEEK (FR).  
6. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) 
Tablet PO DAILY (Daily).  
7. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO three times a 
day for 2 weeks: At 8am, Noon and 4pm daily x 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a 
day as needed for indigestion for 2 weeks: Take 12 hours apart 
from Atazanavir .
Disp:*14 Tablet(s)* Refills:*0*
9. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO twice a 
day for 4 days.
Disp:*8 Tablet(s)* Refills:*0*

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Primary: Variceal bleeding, upper GI bleeding
Secondary: HIV, Hepatitis C

 
Discharge Condition:
Hemodynamically stable and afebrile.

 
Discharge Instructions:
You were admitted after developing black stools concerning for 
bleeding in your gastrointestinal track.  You were treated with 
IV fluids and medications to stop the bleeding.  You also had an 
EGD that revealed a possible source in your prior variceal 
banding.  Now improved with stable blood tests, you are being 
discharge home for further recovery.

Please keep all outpatient appointments.

Please take all medications as prescribed.  You have been 
prescribed two new medications:
- Take Sucralfate 3 times daily, at 8am, noon, 4pm

- Do not take Sucralfate within 4 hours of taking Atazanavir as 
this can decrease absorption

- You can also take Ranitidine for stomach upset.  If you take 
this medication, take it 12 hours apart from Atazanavir because 
this may change the absorption

Return to the ED if you notice persistent black stools, 
lightheadedness, chest pain, difficulty breathing, fevers, 
chills, severe abdominal pain or any other symptoms which are 
concerning to you.
 
Followup Instructions:
___

{'black stools': ['Esophageal varices in diseases classified elsewhere', 'Cirrhosis of liver without mention of alcohol'], 'bleeding': ['Esophageal varices in diseases classified elsewhere', 'Cirrhosis of liver without mention of alcohol'], 'HIV': ['Asymptomatic human immunodeficiency virus [HIV] infection status'], 'Hepatitis C': ['Chronic hepatitis C without mention of hepatic coma'], 'hemophilia': ['Congenital factor VIII disorder'], 'hypertriglyceridemia': ['Other and unspecified hyperlipidemia'], 'WPW tachycardia': ['Anomalous atrioventricular excitation']}