REASON PROCEDURE: Endoscopy. INDICATIONS Patient with lupus erythematosus, dysphagia. I am to rule out esophageal stricture, rule out reflux esophagitis, and consider esophageal motility disorder. PROCEDURE IN DETAIL Time-out was called. Consent signed. IV sedation administered. The forward-viewing endoscope was passed into the esophagus, stomach, then to the second portion of the duodenal without difficulty. Upon withdrawal, the following findings were noted. FINDINGS Duodenum: The first and second portion of the duodenum were evaluated. There was evidence of duodenitis with erythema noted within the duodenal bulb. No specimens were obtained. No ulcerations were seen. Stomach: The stomach was empty of all contents. There was streaky erythema within the antrum consistent with nonerosive gastritis. No specimens are obtained. The proximal stomach was normal. No hiatal hernia seen. …show more content…
There was no hiatal hernia nor is there evidence of reflux esophagitis. The more proximal esophagus had a normal esophageal luminal diameter. There are several white plaques in the proximal to mid esophagus suggesting Candida esophagitis. A biopsy was obtained to confirm this. The procedure at this point was discontinued or terminated. IMPRESSION 1. Candida esophagitis suspected, status post biopsy. 2. No evidence to suggest reflux esophagitis nor other changes suggesting eosinophilic esophagitis. Pathology pending. 3. Nonerosive antral gastritis observed. No specimen obtained. 4. Nonerosive duodenitis observed. No specimens
Strasberg SM (2008). "Acute Calculous Cholecystitis". New England Journal of Medicine 358 (26): 2804–2811. doi: 10.1056/NEJMcp0800929. PMID 18579815
Then after threading a catheter through the needle, the anesthesiologist will withdraw the needle and leave the catheter i...
IV sedation is reserved for our most complicated procedures and patients with very high levels of fear and anxiety. IV sedation creates a sleep-like state that allows you to wake up from a procedure with no memory of the sights, smells, sounds, or sensations that occurred during the treatment. This form of sedation is administered through an intravenous line and only by a licensed
•Jose symptoms is derived from a disorder called Gastroesophageal reflux disease (GERD) occurring in the digestive system with the consumption of food, irritating the esophagus generally causing notable clinical symptoms such as the following: vomiting, chronic cough, angina, & regurgitation immediately after the consumed food. Jose's experience of the lump in his throat is caused by esophageal sphincter pressure.
This machine used an intravenous drip which was hooked up to the patient. The IV would start dripping a solution of saline. When the patient was ready they pushed a button and this solution would stop dripping. At this time the machine would release a drug called thiopental, better known as sodium pentothal, a general anesthesia for sixty seconds. After this the patient would be in a coma. A timer would stop the first drug and the release the next one called potassium chloride. This drug will cause a heart attack and the patient will die in their sleep. (Gibbs, McBride-Mellinger; PBS.org.
What? The patient is 65-year-old man Mr. John Douglas who is suffering from dysphagia and have been admitted to the surgical ward for insertion of a percutaneous endoscopic gastrostomy (PEG). Apart from that, he is a Type 1 diabetes patient and has weakness in his right leg and arm because of right-sided hemiplegia. He is thin in appearance and has stage 1 pressure sore on his right heel.
Rockwell, P.E.,M.D. Director of Anesthesiology, Leonard Hospital, Troy, NY, U.S. Supreme Court, Markle vs. Abele, 72-56, 72-730, 1972. P.11
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Abdomen: His abdomen is soft and nontender, without palpable _____(mass) _____(organomegalia). [Name] has positive bowel sounds.
On October 16th, 1846 the world of surgery changed forever. Taking place in the Ether Dome at Mass General Hospital was the surgical removal of a tumor in a man’s neck. The surgeon was the world renowned Doctor John Warren. Before Doctor Warren could slice into the man’s neck, William TJ Morten, a dentist, ran into the room. He presented a bag filled with a gas called Ether, and swore that he could erase all of the patient’s pain. He had tested this gas on himself, his dog, and his goldfish. Doctor John Warren gave him permission to try out this relatively untested gas on his patient. For the first time in surgical history, the Ether Dome stayed silent throughout the surgery. No screaming, no flailing, and no burly men needed to hold the patient down (Decoding The Void). Soon Doctors all over the world were using general anesthesia, and history was made.
A common condition that is associated with GERD and LES problems is having a hiatal hernia. A hiatal hernia is when you have a larger than normal opening in the diaphragm where the esophagus passes through. Since this opening is larger, the stomach begins to enter this opening. When you eat, the stomach and esophagus ...
Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., Edwards, F. D. (2008). Diagnosis
Dr. Tagge, the lead surgeon, finally updated the family over two and a half hours later stating that Lewis did well even though he had to reposition the metal bar four times for correct placement (Kumar, 2008; Monk, 2002). Helen reported wondering if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a year ago in the office, especially considering he did not lay eyes on Lewis until he was under anesthesia the day of surgery (Kumar, 2008). In the recovery room, Lewis was conscious and alert with good vital signs, listing his pain as a three out of ten (Monk, 2002). Nurses and doctors in the recovery area charted that he had not produced any urine in his catheter despite intravenous hydration (Kumar, 2008; Monk, 2002). Epidural opioid analgesia was administered post-operatively for pain control, but was supplemented every six hours by intravenous Toradol (Ketorolac) (Kumar, 2008; Solidline Media,
This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss.
MEDICAL DIAGNOSIS: Empyema, Hemoptysis, Necrotizing pneumonia, Aspergillosis (Aspergillus fumigatus) cachexia secondary to malnutrition/infection, hypothyroidism, Diabetes Type II melitius , and...