Reshma Mulla, MD - 12/19/2025 6:25 AM CSTFormatting of this note is different from the original.Images from the original note were not included.Hepatobiliary Surgery Daily Progress HPI:Mr. Alexander R Towell is a 50 y.o. year old admitted for Metastatic colon cancer to liverLength of Hospitalization: 1Post Procedure Day: 12/18/2025 Procedure(s):XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED SEGMENT 5 8 and 4B, INTRAOPERATIVE ULTRASOUND and TAP BLOCK SUBJECTIVE/ INTERVAL HISTORY-Patient denies uncontrolled pain, nausea, fever, shortness of breath. -No AEON-Voided urine around 500 ml-denies any nausea or vomiting-pain well controlled Objective Physical Exam Constitutional: Appears comfortable. Lying in bed. No distress. HENT: No nasal cannula nor NGT Eyes: Conjunctivae are normal. Pulmonary/Chest: Effort normal No respiratory distress. No grossly audible wheezes nor ralesAbdominal: Soft. No distension. Appropriately tender. Incision closed with dermabond no warmth, erythema, fluctuance, drainage. No drain . There is no rebound and no guarding. Musculoskeletal: Normal range of motion. No edema or deformity. Neurological: Alert and oriented to person, place, and time. Skin: Skin is warm and dry. No rash noted. Not diaphoretic. No erythema. Psychiatric: Normal mood and affect. Current Facility-Administered Medications: acetaminophen (TYLENOL) tablet 1,000 mg, 1,000 mg, oral, Q6H SCH, 1,000 mg at 12/19/25 0538 Carrier Fluids for Secondary Infusion - 0.9% Sodium Chloride, 30 mL, intravenous, PRN enoxaparin (LOVENOX) syringe 40 mg, 40 mg, subcutaneous, Daily-2100, 40 mg at 12/18/25 2042 gabapentin (NEURONTIN) capsule 100 mg, 100 mg, oral, BID, 100 mg at 12/18/25 2042 levothyroxine (SYNTHROID) tablet 125 mcg, 125 mcg, oral, Daily - 0600, 125 mcg at 12/19/25 0538 lidocaine (LIDODERM) 5 % patch 1 patch, 1 patch, transdermal, Q24H methocarbamoL (ROBAXIN) tablet 1,000 mg, 1,000 mg, oral, TID, 1,000 mg at 12/18/25 2042 ondansetron (ZOFRAN) injection 4 mg, 4 mg, intravenous, Q6H PRN oxyCODONE (ROXICODONE) tablet 5 mg, 5 mg, oral, Q4H PRN, 5 mg at 12/18/25 1831 propranoloL (INDERAL) tablet 20 mg, 20 mg, oral, Daily - 0600, 20 mg at 12/19/25 0538 senna-docusate (PERICOLACE) 8.6-50 mg per tablet 1 tablet, 1 tablet, oral, BID, 1 tablet at 12/18/25 2042 sodium chloride 0.9% flush 0.5-20 mL, 0.5-20 mL, intra-catheter, Q8H SCH (ALT), 10 mL at 12/18/25 2042 sodium chloride 0.9% flush 0.5-20 mL, 0.5-20 mL, intra-catheter, PRNLab/Radiology/Diagnostic Review:Laboratory studies from the past 24 hours were reviewed and significant forHematology Lab History Latest Ref Rng & Units 11/6/2025 09:13 11/20/2025 07:58 11/26/2025 10:50 12/19/2025 04:12 Labs - Hematology WBC 3.80 - 9.90 K/cumm 5.69 4.35 5.39 9.25 Total Hb, POC 13.0 - 17.5 g/dL 15.5 15.3 15.3 14.3 Hct 38.9 - 50.3 % 44.5 43.9 45.8 41.4 Plt 150 - 400 K/cumm 160 131 204 164 Neutrophil abs 1.50 - 6.50 K/cumm 3.35 2.66 Lymphocytes, abs 0.80 - 3.30 K/cumm 1.56 0.95 Chem/LFT Lab History Latest Ref Rng & Units 10/23/2025 12:31 11/6/2025 09:13 11/20/2025 07:58 12/19/2025 04:12 Labs-Chem/LFT Sodium 135 - 145 mmol/L 141 137 140 137 Creatinine 0.80 - 1.30 mg/dL 1.05 1.07 1.11 1.12 Bilirubin, total 0.1 - 1.2 mg/dL 0.6 0.7 0.9 1.1 AST 10 - 50 Units/L 24 23 28 105 ALT 7 - 55 Units/L 36 29 46 101 Alk phos 40 - 130 Units/L 68 71 80 71 CrCl- Actual Body Weight (Cockcroft-Gault) 123.1 121.7 117 113.9 No results found for: “AMYLASEFL"Recent Radiology studies were reviewed and significant for: PET/CT imaging(11/19/2025)Suggestion of subtle uptake in the area of queriedhepatic segment 4A enhancing lesion on recent MRI, which mayrepresent metastasis versus physiologic artifact. No evidence ofhypermetabolic disease elsewhere.MRI Abdomen and Pelvis(11/11/2025)-Interval development of two hepatic segment 4A/8 lesions, suspiciousfor metastatic disease.Vitals:24hr Min/Max:Temp Min: 36.3 °C (97.4 °F) Max: 36.9 °C (98.4 °F)Pulse Min: 50 Max: 78BP Min: 102/68 Max: 166/100Resp Min: 12 Max: 25SpO2 Min: 92 % Max: 98 %Most Recent:Vitals: 12/19/25 0538 BP: 110/64 Pulse: 67 Resp: Temp: SpO2: I/O last 2 completed shifts:In: 1313.7 [I.V.:1313.7]Out: 820 [Urine:800; Blood:20]I/O this shift:In: 273.2 [P.O.:50; I.V.:223.2]Out: 350 [Urine:350]Recent Interventions: Assessment/Plan 1. Metastatic colon cancer to liver2.Advance diet as tolerated3.OOBC4. DischargeReshma Mulla, MD12/19/20256:26 AM Cosigned by William Chapman, MD at 12/19/2025 9:10 PM CSTElectronically signed by Reshma Mulla, MD at 12/19/2025 12:22 PM CSTElectronically signed by William Chapman, MD at 12/19/2025 9:10 PM CSTRiadh Cheddadi, MD - 12/18/2025 7:20 PM CSTFormatting of this note is different from the original.Surgery Post Op Check NoteAlexander R Towell8/4/1975104670153Pt returns from the OR 12/18/2025 s/p XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED SEGMENT 5 8 and 4B, INTRAOPERATIVE ULTRASOUND and TAP BLOCK by Chapman, William Cavanaugh, MD for Pre-op Diagnosis * Metastatic colon cancer to liver [C18.9, C78.7]Patient transferred from PACU to floor in stable condition. Patient is resting comfortably in bed. Pain controlled with scheduled and PRN medication. Denies nausea, emesis, chest pain, or SOB. Vital signs have been reviewed and are stable.Diet: Dietary Orders (From admission, onward) Start Ordered 12/18/25 1808 Adult Diet Clear Liquid Diet effective now Question: (BJH) Diet type Answer: Clear Liquid 12/18/25 1807 Physical Exam:Vitals: 12/18/25 1905 BP: 141/88 Pulse: 57 Resp: 18 Temp: 36.3 °C (97.4 °F) SpO2: 98% Constitutional: Alert and oriented x4 and no acute distressCV: Regular rate.Pulm: Unlabored respirations. Equal and symmetric chest rise.Abdomen: Soft, appropriately tender, nondistended. Incisions c/d/i with no active drainage or bleeding. No hematoma noted. No rebound tenderness or involuntary guarding. Neuro: Grossly nonfocal.Extremities: Warm and well perfused.Assessment and PlanThe patient is doing well in the immediate postop period following- CLD- mIVF- Multimodal pain control regimen- Follow up PM labs- DVT ppx- Encourage OOB and IS use Riadh Cheddadi, MDGeneral Surgery ResidentElectronically signed by Riadh Cheddadi, MD at 12/18/2025 7:20 PM CSTdocumented in this encounter