PIG Meeting: 24th June 2021
72yo male for gastroscopy and colonoscopy due to upper GIH and obstructive colonic symptoms
- Presumed sarcoidosis (hasn’t attended F/U) with mediastinal adenopathy
- ? metastatic lung malignancy. Previous effusion (? parapneumonic) drainage showed no malignant cells. Effusion now recurred. Nodules in lungs stable on repeat CT.
- Severe cardiac disease
- TTE 2021 (in context of admission for anaemia) Severely dilated left ventricle with severe RWMAs. EF 26%. Moderately dilated right ventricle with moderate systolic dysfunction. Moderate AS and AR. Mild to moderate MR. Moderately dilated atria.
- IHD – AMI ’09, PCI
- PHTN – mod/severe at rest.
- TIA 2018
- Recent exercise tolerance reduction. Gentle incline, 100m, multiple breaks for SOB.
- ? malignancy
- ? cardiac component to dyspnoea
- Patient psychosocial issues
- Difficult historian
- DNA for multiple appointments and investigations previously
- Patient declined face-to-face review in clinic
- Surgical team unaware of multiple other complex issues
- Fit for endoscopies?
- Greater issue is the benefit from these procedures. Diagnostic rather than therapeutic.
- Surgical team has highlighted that if metastatic lung disease present, endoscopies may not need to occur
- Difficult to know from history alone.
- Requires face to face review
- Admit for TTE (as unable to secure timely booking pre-admission)
- Respiratory team will review while inpatient
- Pending these reviews and pleural fluid drainage, endoscopies may proceed
- Requires inpatient admission for bowel prep regardless due to multiple severe comorbidities