ERCP can be used both for diagnostic as well as therapeutic purposes. The main indications are choledocholithiasis, strictures, diagnosis and management of biliary and pancreatic neoplasms and post operative management of bile leaks after cholecystectomy. The main complications of ERCP are pancreatitis, hemorrhage, perforation, infection and rarely retroperitoneal abscess following perforation. We report a case of 90 year old women who presented with shortness of breath and was found to have retroperitoneal abscess on radiological imaging as an incidental finding. Case Report: A 89 year old female with past medical history of hypertension presented with shortness of breath for four days. She recently had ERCP with sphincterotomy and stent placement
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
They can be enumerated as difficult entry to the right hypochondrium owing to the adhesions, difficulty in exposure can also arise due to diseased gallbladder and Liver ,acutely inflamed and tense gallbladder ,gallbladder packed with stones ,thick walled gallbladder ,fibrotic gallbladder ,gallbladder mass and abnormality can also arise due to anomalous anatomy of hepatobiliary system like situs inversus, malposition of the gallbladder, arterial anomalies and short cystic duct, a huge stone impacted in the cystic duct, Hartmann’s pouch adherent to the common hepatic duct and anomalous insertion of the cystic duct.
Liver percusses to 8 cm at midclavicular line, one fingerbreadth below right costal margin: This indicates that the patient does not have signs or symptoms of liver disease or ascites.
Acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) appears to be the most frequent major complication, occurring in 1-10% of patients overall, with a mortality rate ranging from 0.2-0.6% and an annual healthcare expenditure cost reaching $150 million in USA alone (1) (2). Several risk factors have been reported to play a role in ERCP-induced pancreatitis; some are patient-related (i.e. sphincter of Oddi dysfunction (SOD), female gender, history of pancreatitis, pancreatic acinar opacification), while others are procedure-related (i.e. precut or needle-knife endoscopic sphincterotomy, repeated pancreatic duct injection, difficult cannulation), and this may be useful in stratifying patients into low-risk or and high-risk categories (3).
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
The laparoscope was inserted and the remaining ports were placed visualizing their placement with a laparoscope. An 11 mm port was placed in the subxiphoid location, and two 5 mm ports were placed laterally under the right subcostal (rib) margin. The gallbladder was identified. It was edematous, acutely inflamed. It was grasped with the fundus and retracted in a (cephalad) direction. There were no omental adhesions adherent to the gallbladder that were taken down sharply. The neck was then grasped along the lateral most ports and retracted in a lateral direction. The cone bile duct was identified and care taken to avoid injury to this structure. The cystic artery and cystic duct were identified, mobilized, doubly ligated with endoclips and then divided. The gallbladder was dissected free from the liver with the electrocautery. The specimen was placed in an (Endo Catch) (sac), and was removed through the umbilical incision with no difficulty. The Hassan trocar was reinserted into the abdomen, reinflated the suprahepatic lymphatic space was irrigated copiously with normal saline. Adequate hemostasis was obtained in the gallbladder fossa with the electrocautery. The 360 degree
Adults A Child and Youth Professional (CYC) supports adults in their lives in countless ways. They act as advocates, mentors and teachers to parents that are or have been in difficult situations. Some of these situations are, but not limited to, teaching parents to cook and clean, creating a safe environment for their children that may be involved, and facilitating crisis intervention. As a CYC helping parents and young adults, there are two approaches that are used. The term for the first approach is the surface approach.
Pulmonary hypertension occurs with elevated pulmonary artery and pulmonary capillary wedge pressures (Chopra, Badyal, Baby, & Cherian, 2012). Patients with pulmonary hypertension will typically present with dyspnea on exertion (Chopra et al., 2012). As the disease progresses, symptoms such as orthopnea, edema, angina, and heart murmurs may occur (Chopra et al., 2012). Pulmonary hypertension can be idiopathic or can develop due to street drug use, portal hypertension, and collagen vascular disease (Chopra et al., 2012). Pulmonary hypertension can lead to right-sided heart failure (Chopra et al., 2012). Pulmonary hypertension is diagnosed through chest x-ray, EKG, echocardiogram, and cardiac catheterization (Chopra et al., 2012). The dyspnea on exertion and orthopnea that the patient is experiencing may be linked to pulmonary hypertension. However, the other symptoms do not match this diagnosis. If the patient has heart failure it is probable that pulmonary hypertension can
The magazine from Mount Ararat Baptist Church, the respondent, has provided relevant evidence for the sex discrimination as well as the aiding and abetting cases before the Pennsylvania Human Relations Commission (PHRC). Due to this new information the PHRC needs to expand its investigation for the duration of time employees with their gender holding the position of Accounting Assistant at MABC, if any.
The doctor first misdiagnosed her condition as an aggravated gallbladder. However, after diet modifications, symptoms continued to return and worsen resulting in her referral to a rheumatologist (https://www.netce.com/casestudies.php?courseid=1121).
...problem that lead him to this hospitalization. A reevaluation after 21 days was ordered by the doctor to determine if the herbs were the contributing factor to the patients’ chest pain and shortness of breath due to tachycardia.
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Enterprise Resource Planning (ERP) -. Abstract ERP systems are meant to help companies and businesses operate more efficiently when they are not. The main goal for a company is to choose a vendor that will give them the safest and easiest way to operate efficiently and achieve their business goals. What is an ERP?
In conclusion, early diagnosis followed by an appropriate airway intervention is essential to prevent cardiac arrest or irreversible brain damage that occurs within minutes of complete airway obstruction. Although the conventional techniques remains standard option, every physician has to be familiar with the process of evaluating a difficult airway and, in the event of the unanticipated difficult airway and be able to use a wide variety of techniques to avoid complications and fatality. Airway management of the patient requires a coordinated effort from other consultants or colleagues, if available, can be the key to success in some circumstances.