Sent 02/23/2026 12:10:21, Page - 26

FRASER HEALTH AUTHORITY Discharge Summary
HOLAND,MARK THOMAS
RC03030788

2. Sumatriptan 25mg PO daily PRN for migraines.

DISCHARGE DISPOSITION
Mr. Holand was discharged home in stable condition.

POST-DISCHARGE FOLLOW-UP

Mr. Holand will follow up with his family doctor. We kindly ask his family

doctor to follow up on repeat bloodwork which we have given him a requisition
for to complete in 1 week and ensure stable hemoglobin. A urine culture was
also sent as the patient had some symptoms of dysuria, but this occurred after
shortly after Foley catheter removal. If he has ongoing lower urinary symptoms
and a positive urine culture, he can be considered for UTI treatment.

We have provided the patient with the following return-to-care instructions. We
have asked that he seek medical attention should he develop BRBPR, melena,
hematemesis, coffee ground emesis, severe lightheadedness, or any other
concerns.

HPI/COURSE IN HOSPITAL

Mr. Holand is a 43-year-old male patient who presented to RCH ED with brisk

upper GI bleed in the morning of March 8, 2022. At the time of presentation, he

reported 6 weeks of worsening epigastric pain, worse when lying down but not
associated with PO intake. He was taking NSAIDs increasingly (in addition to

Naproxen which he was taking for migraines), mostly ibuprofen or Aspirin, up to

4 per day. He woke up in the morning of Mar 8 feeling weak and unwell. He went

to the bathroom and fell to the ground because of weakness, He then had an

episode of large hematemesis and had a short LOC. He had some urinary
incontinence during LOC but no bowel Incontinence or postictal confusion. He
then had BREPR with bloody diarrhea, and EMS was called to bring the patient to
the hospital. He was found to have a brisk upper GI bleed with hemodynamic
instability, and required urgent endoscopy. His course was follows:

1. Upper GI bleed: When he arrived in the ED, he appeared very pale and weak,
with BP around 70/50. He was given PRBC transfusion, fluids, and PPI
infusion and was taken urgently for EGD. EGD revealed a small but deep
ulcer in the 1st part of the duodenum with active bleeding. Hemostasis was
unsuccessful during EGD, and he was transferred to IR for embolization.
Although the embolization was technically challenging due to the aberrant
celiac and SMA arterial anatomy, a superior pancreaticoduodenal artery was
found to have marked hypertrophy and as the likely culprit vessel and was
embolized, resulting in successful hemostasis. In total, Mr. Holand
received 4 units of PRBC, and his blood pressure and hemoglobin normalized
appropriately following the transfusion and IR embolization. He did not
have any further episode of BRBPR, melena, hematemesis, or coffee ground
emesis during his admission, and hemoglobin remained stable. He was given
IV PPI for 72 hours and was switched to pantoprazole 40mg PO BID on Mar 11.
He also received iron sucrose for 2 days. He was advised not to use any
NSAIDs (e.g. Naproxen, aspirin, ibuprofen) in the future.

2. COVID positive: Upon routine COVID test at admission, Mr. Holand was found
to be positive for COVID incidentally. He denied any COVID symptoms
including dyspnea, fever, chills, or rhinorrhea. He remained completely
asymptomatic throughout the stay with no increase in O2 requirement, and he
did not require any treatment. He was recently infected in January 2022
with COVID, and so this test result may reflect persistent test positivity
versus reinfection.

Thank you for involving Us in the care of this patient.

. Meditech Report ID: 1103-1759
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