-Gastroenterologist Dr. Green X 2 for vomiting, EGD and upper GI series. EGD was completed at VBMC in 10/4/17, recommendation for Omeprazole 40 mg PO BID, high fiber diet, and anti-reflux measures; diagnosis of Small Hiatal hernia, Gastritis. Pathology report indicated “increased chronic inflammation to include occassional eosinophils -No Squasmous epithelium present -No Ulcer, ativity, Dysplasia or Malignancy -IHC stain for Helicobacter pylori is negative.
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
Laryngopharyngeal Reflux (LPR) is the retrograde movement of stomach contents above the upper esophageal sphincter and into the larynx, pharynx, and upper aerodigestive tract (Belafsky, Postma, & Koufman, 2001). This condition is seen in high numbers in voice clinics across the country. In a study of 113 consecutive new patients seen for voice disorders, Koufman, Amin, and Panetti (2000) found that the prevalence of LPR was 50% and symptoms and exam findings were found in 69% of new patients. The epithelial lining of the larynx and pharynx do not have the cellular structure to withstand acidic stomach contents like the epithelium of the esophagus, and small
Patient was NPO (nothing by mouth) prior to her surgery due to preparation for anesthesia, and after surgery the patient was back on her normal diet with no restrictions. Upon her elimination assessment, bowel sounds were present in all four quadrants. Abdomen appeared soft and was non-tender. Liver span is normal, and her spleen is not palpable. No other masses were palpated and hernia sites are normal. The patient has a suprapubic catheter that is draining
Warning signs that appear during the Clinical Swallow Evaluation can give the clinician insight into the possible results of a more formal Video Fleuroscopic Swallow Study (VFSS). If aspiration is suspected during the CSE it is 10 times more like to show up on VFSS. A Clinical Swallow Evaluation assesses neuromuscular, behavioral, and environmental factors involved in successful swallowing and eating. This comprehensive view of eating and swallowing provides valuable insight in determining intervention methods and potential complications.
It is performed in the video fluoroscopy suite within a hospital. This involves the radiologist, a radiology technologist and a speech-language pathologist. The patient must be seated in an upright position and fed barium coated food, while being x-rayed. The MBSS study is time limited in order to reduce the volume of radiation exposure to the patient. We ask if this time is suitable for impact of fatigue on a patient’s ability to swallow effectively. Food and liquid consistencies are simulated through the use of liquid barium and or barium paste. This May be taken of specific abnormalities, and the entire test may be recorded on videotape for later viewing. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a procedure designed to assess swallowing function through the use of visualization and imaging to examine the pharyngeal and laryngeal structures. The portable study uses a flexible fiber optic laryngoscope which is passed transnasally. The scope hangs above the epiglottis and does not pass between the vocal folds. Patients are seated in a functional feeding position and are offered a variety of food consistencies while the swallow is viewed on a monitor. The study is recorded and saved in the medical
Diagnosis of the ulcerative disease involves radiographic and endoscopic evaluation of the upper GI tract and testing for H. pylori colonization. Even though he takes NSAIDs, it is recommended that he gets tested for H. pylori. Other tests that can be ordered
His vital signs and blood work are all within normal range. Additional blood work test include, amylase and lipase measurements to rule out pancreatitis, erythrocyte sedimentation rate (ESR) to detect inflammatory activity in the body, abdominal x-ray to look for any masses and endoscopy to inspect the esophagus for any lesions. A CT scan or an MRI may be done to identify the cause of epigastric pain as well depending on the other symptoms he may be experiencing (Kerkar, 2016). There are other variables to consider while evaluating TJ case. He has a previous history of bleeding ulcer that was treated with multiple prescriptions although he did not complete his therapy course. TJ is at a risk of peptic ulceration due to usage of over-the-counter (OTC) NSAIDs that he takes for his osteoarthritis pain. NSAIDs are linked with gastric mucosal damage and ulcer formation which consequently result to gastrointestinal (GI) bleeding. NSAIDs should be
William Lively is a 50-year-old male who complains of epigastric, nausea, and mid-back pain. Last month the patient was admitted to the hospital due to severe epigastric and mid-back pain. This was accompanied with vomiting and nausea. The patient reports that he has experience abdominal pain that has been irregular for 7 years due to other digestive problems. He has been diagnosed with chronic constipation, and Irritable Bowel Syndrome. In 2011, he had his gallbladder removed. The patient reports that since his hospitalization his health has improved. He has stopped vomiting, but continues to have irregular nausea which is cured by omeprazole. Sometimes on a scale to 10, the patient rates the pain an 8 and after pain medication, her pain