Toxic gastroenteritis and colitis Obstruction of bile duct Malignant neoplasm of head of pancreas Other secondary thrombocytopenia Dehydration Essential (primary) hypertension Gastro-esophageal reflux disease without esophagitis Nausea Adverse effect of antineoplastic and immunosuppressive drugs initial encounter Unspecified place or not applicable
 
Name:  ___                  Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: MEDICINE
 
Allergies: 
latex
 
Attending: ___.
 
Chief Complaint:
diarrhea
 
Major Surgical or Invasive Procedure:
None

 
History of Present Illness:
Ms. ___ is a pleasant ___ w/ HTN, DL, congenital
deafness, and recently diagnosed borderline resectable 
pancreatic
head adenocarcinoma, on neoadjuvant C1D21 Folfirinox who 
presents
for diarrhea for two days.

She had ERCP with stent placement done yesterday. No
complications with that. She reports multiple episodes of watery
brown non-bloody diarrhea for the past two days. She reports not
eating or drinking as much over the past several months. Also
some nausea on and off over the same time period. She reports
mild gas pain but denies abdominal pain and vomiting.

In ED, initial vitals were Temp 97.7, HR 91, BP 102/65, RR 15, 
O2
sat 98% RA. She received 1L NS. CXR was negative for infection.
Vitals prior to transfer were Temp 98.1, HR 77, BP 106/66, RR 
16,
O2 sat 100% RA.

On arrival to the floor, she reports that she is feeling well.
She denies fevers/chills, headache, dizziness/lightheadedness,
shortness of breath, cough, chest pain, palpitations, abdominal
pain, vomiting, constipation, dysuria, and rashes.

 
Past Medical History:
HTN 
congenital deafness
GERD
Goiter
 
Social History:
___
Family History:
Father passed away from complications of gangrenous colitis.
Mother with T2DM.
Sister with colon CA.
Sister deceased, ___.
 
Physical Exam:
ADMISSION PHYSICAL EXAM:  
VS: Temp 97.3, BP 125/89, HR 69, RR 18, O2 sat 100% RA.
GENERAL: Pleasant woman, in no distress, lying in bed
comfortably.
HEENT: Anicteric, PERLL, OP clear.
CARDIAC: RRR, normal s1/s2, no m/r/g.
LUNG: Appears in no respiratory distress, clear to auscultation
bilaterally, no crackles, wheezes, or rhonchi.
ABD: Normal bowel sounds, soft, nontender, nondistended, no
hepatomegaly, no splenomegaly.
EXT: Warm, well perfused, no lower extremity edema, erythema or
tenderness.
NEURO: Alert, oriented, good attention and linear thought, CN
II-XII intact. Strength full throughout.
SKIN: No significant rashes.
 
 
Brief Hospital Course:
___ is a pleasant ___ w/ HTN, DL, congenital deafness, and 
recently diagnosed borderline resectable pancreatic head 
adenocarcinoma, on neoadjuvant C1D21
Folfirinox who presents for diarrhea for two days. 

Diarrhea- She has 2 loose watery diarrhea everyday mostly at AM. 
Her stool c diff was negative. She was started on Imodium and 
the dose was titrated up to 4mg TID but she still continued to 
have loose watery diarrhea. Her diarrhea is most likely from 
Irinotecan. She was also started on peptobismol to help her 
diarrhea

Elevated Lipase- She had a mild elevation of lipase levels but 
this is likely from her having a ERCP on the day prior to 
admission. She does not have any epigastric abdominal pain or 
lipase levels high enough to suspect pancreatitis.

 Her blood and urine cultures were negative during this 
admission. She was discharged home in a stable condition.
 
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Lisinopril 20 mg PO DAILY 
2. Omeprazole 20 mg PO DAILY 
3. Ondansetron 8 mg PO Q8H:PRN nausea/vomiting 
4. LORazepam 0.5 mg PO BID:PRN anxiety,nausea 
5. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting 
6. TraMADol 50-100 mg PO Q6H:PRN Pain - Moderate 
7. Dexamethasone 4 mg PO BID 

 
Discharge Medications:
1.  Bismuth Subsalicylate 30 mL PO TID 
___ cause black discoloration of stool 
RX *bismuth subsalicylate [Bismatrol] 525 mg/15 mL 15 ml by 
mouth three times daily Refills:*0 
2.  LOPERamide 4 mg PO Q8H 
RX *loperamide 2 mg 2 tablets by mouth three times daily Disp 
#*50 Capsule Refills:*1 
3.  Dexamethasone 4 mg PO BID 
take for 2 days after chemotherapy  
4.  Lisinopril 20 mg PO DAILY  
5.  LORazepam 0.5 mg PO BID:PRN anxiety,nausea 
RX *lorazepam 0.5 mg 1 tablet by mouth twice daily Disp #*30 
Tablet Refills:*1 
6.  Omeprazole 20 mg PO DAILY  
7.  Ondansetron 8 mg PO Q8H:PRN nausea/vomiting  
8.  Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting  
9.  TraMADol 50-100 mg PO Q6H:PRN Pain - Moderate  

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Diarrhea-likely from Irinotecan.
Pancreatic cancer

 
Discharge Condition:
stable
alert and oriented to time place and person
independent ambulation

 
Discharge Instructions:
Dear ___,

 It was a pleasure taking care of you. You were admitted since 
you developed loose stools. We found out that you had no 
infections causing the diarrhea. It is likely a adverse reaction 
from chemotherapy agent.

 Please take Imodium and Peptobismol as directed until your 
diarrhea is controlled.

 Please follow up for your appointment with ___ on 
___.

Sincerely,
___ MD
 
Followup Instructions:
___

{'diarrhea': ['Toxic gastroenteritis and colitis', 'Adverse effect of antineoplastic and immunosuppressive drugs'], 'nausea': ['Adverse effect of antineoplastic and immunosuppressive drugs'], 'gas pain': [], 'abdominal pain': []}