Summary Assignment: Historical Influencement For Physical Slavery Statement

PATIENT: 4 MINUTES
PRESENTING PHYSICIAN: 66-YEAR OLD MAN WITH A PAST MEDICAL HISTORY RELEVANT FOR MYOCARDINAL INFARCTION (sp?) SECONDARY TO CORONARY ARTERY DISEASE, HYPERLIPIDEMIA, PERIPHERAL VASCULAR DISEASE WITH INTERMITTENT CLAUDICATION (sp???) AND SLEEP APNEA. HE HAS A HSTORY OF TOBACCO EXPOSURE AND NO HISTORY OF ALCOHOL USE.. PATIENT PRESENTED WITH EPIGASTRIC PAIN OVER A 3-MONTH PERIOD AND SUBSEQUENTLY HAD ONE EPISODE OF GASTROINTESTINAL BLEEDING THAT REQUIRED ADMISSION. DURING THAT ADMISSION A COMPLETE WORKUP WAS PERFORMED INCLUDING AN EGD THAT REVEALED THE PRESENCE OF AN ULCERATED AND FRIABLE MASS IN THE GASTRIC FUNDUS AS WELL AS MILD GASTRITIS IN THE ANTRUM.
PATHOLOGIST: BIOPSIES DEMONSTRATED INVASIVE ADENOCARCINOMA.
SURGEON: DO WE

THERE IS NO EVIDENCE OF DISTANT METASTATIC DISEASE. A COMBINED PET AND CT CONFIRMS THE PRESENCE OF INCRESED UPTAKE IN THE POSTERIOR ASPECT OF THE FUNDUS AND IN REGIONAL LYMPH NODES. ENDOSCOPIC ULTRASOUND EXAMINATION REVEALS TUMOR IN THE GASTRIC WALL INVOLVING THE MUSCULAIS PROPRIA WITH ENLARGED LYMPH NODES IN THE VICINITY.
SURGEON: HE IS A CANDIDATE FOR TOTAL GASTRECTOMY WITH ROUXEN-Y ESOPHAGOJEJUNOSTOMY (SP?). HE NEEDS A FEEDING TUBE.
[PRESENTING PHYSICIAN NODS IN AGREEMENT]
PRESENTING PHYSICIAN: CAN YOU SEE HIM THIS WEEK?
[SURGEON NODS]

NEXT PATIENT: 1 MINUTE,

HE ALSO NOTED THE PRESENCE OF FECERS AND ___________AT THE TIME. HIS PRIMARY CARE PHYSICIAN ORDERED AN ABDOMINAL ULTRASOUND THAT REVEALED THE PRESENCE OF MULTIPLE LIVER LESIONS. A CT SCAN OF THE CHEST, ABDOMEN AND PELVIS CONFIRMED THE PRESECE OF MORE THAN 30 LOW-ATTENUATION LIVER LESIONS AND ENHANCING MASS RISING ROM THE LESSER CURVATURE OF THE STOMACH AND _________________LUMPH NODES ALONG THE ________ LIGAMENT. BIOPSY OF ONE OF THE LIVER LESIONS WAS POSITIVE FOR UNDIFFERENTIATED CARCINOMA. AN ENDOSCOPY WAS SUBSEQUENTLY PERFORMED AND VISUALIZED A LARGE, FUNGATING, ULCERATED MASS ARISING IN THE ________THAT EXTENDED INTO THE GASTRIC BODY IN THE LESSER _______.
MO: LABS?
PATHOLOGIST: BIOPSIES WERE POSITIVE FOR ANAPLASTIC CARCINOMA. IMMUNOHISTOCHEMICAL STAINING FOR HER2/NEU ON THE STOMACH LESION WAS NEGATIVE. LABORATORY STUDIES DEMONSTRATED MILDLY DECREASED HEMOGLOBIN OF 10.6 G/DL, A NORMAL CREATININE VALUE OF .7 MG/DL (??) AND ABNORMAL LIVER FUNCTION RESTS RELEVANT FOR AST OF 42 _________?? ALK OF 194 IU/L BUT WITH A TOTAL BILIRUBIN WITHIN THE NORMAL RANGE. I SUSPECT STAGE 4 GASTRIC CANCER.
IR: I WOULD LIKE TO REFER TO MEDICAL ONCOLOGY. I AM NOT SURE WHY HE CAME TO ME FIRST OTHER THAN ROBERT RECOMMENDED HIM TO ME AS A