REASON
PROCEDURE: Endoscopy.
INDICATIONS
Recurrent esophageal stricture. Patient with personal history of stage I adenocarcinoma of the esophagus in the setting of Barrett's esophagus, diagnosed elsewhere. He has a history of a distal esophagectomy with a gastroesophageal reanastomosis performed at or near 09/2016. The patient at one point, had a tracheostomy which has been removed. At one point, a feeding jejunostomy tube that has been removed. He has recurrent dysphagia and previous endoscopic dilatation. He presents today for a repeat endoscopy with probable dilatation of the EG junction.
PROCEDURE IN DETAIL
Timeout was called. Consent signed. IV sedation administered. The forward-viewing endoscope was passed into the esophagus without difficulty. I was able to advance the scope without obstruction through the neo gastric esophageal anastomosis. There is slight narrowing seen, nonobstructive. The stomach was entered and at that point, I found residual food contents. The pylorus was located
…show more content…
No ulcer or erosion. No pathology was obtained.
Stomach: There was residual semi-digested food within the gastric antrum. There was deformity to the gastric anatomy likely due to his surgery. There was no obstruction to gastric outlet likely delayed emptying is functional. No gastric mucosal lesions were seen.
The esophagogastric junction was located 30 cm from the incisors. There was evidence of edema, a slight stricture which is nonobstructive, and a benign-appearing ulceration indicative of ongoing acid reflux. The esophagogastric junction was dilated to a maximum achieved today a 15 mm which should prove adequate for food advancement. Blood loss was minimal. I also biopsied the EG junction ulcer. This appears benign. Biopsies were obtained to rule out malignancy. The more proximal esophagus was normal. The EG junction lies 30 cm distal to the incisor teeth. The procedure then was
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.
Authors have a variety of motives for writing, which are termed as the author’s purpose. The four main purposes for writing are to express oneself, to explain or inform, to entertain, or to persuade. In the nonfiction story, "The First Appendectomy" written by Dr. William Nolen, the author's purpose is to inform.
1There are dangers involved with Gastric Bypass surgery. Case studies show high insulin levels following meals, confusion, shaking, sweating, headaches and black outs. The patients eventually needed partial or complete removal of the pancreas, in order to prevent dangerous declines in blood glucose. Patients also experienced Dumping Syndrome, when the small intestine fills too quickly with undigested food from the stomach which can cause abdominal cramp and diarrhea. Other research has uncovered a higher-than-expected risk of death following surgery for obesity, even among younger patients.
Gynaecological surgery refers to surgery performed on the female reproductive system For the purpose of this essay, I am going to discuss the role of the midwife in the care and management of a woman who has undergone a hysterectomy. Hysterectomy is the surgical removal of the uterus (Oxford Dictionary of Nursing, 2014). It is major gynaecological surgery and the immediate post operative period is a very important time for recovery. As with every surgery, there are the associated risks attached. According to O'Connor et al, 2004, there is a 2% risk of infection, haemorrhage 0.5% and mortality 6-11 per 1000 regardless of which surgical method is used for the hysterectomy. Therefore, I am going to use relevant literature and guidelines to discuss
•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.
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
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 do not join as they were properly intended and cause malfunctioning of the LES. In some cases, food remains above the LES allowing it to easily travel back up the esophagus.
The second type of dysphagia is called Esophageal dysphagia. This type dysphagia is characterized by the diminished ability to move food through the esophagus (Eisenstadt, pg. 18). This may cause chest pain or cause the patient to spit up their f...
Upper endoscopy this is where a thin flexible tube (endoscope) with a light and camera on it is put down your throat to look at an check for areas that are affected or inflamed (esophagitis). During this procedure samples can also be taken (biopsy) to check for Barrett's esophagus.
On his initial examination dated 23/06/13 the patient was seen for a routine full mouth scale and polish with reinforced oral hygiene instruction including flossing technique. He presented with excellent oral hygiene at this appointment which was a reflection of his commitment to good oral hygiene; tooth-brushing twice daily and dental flossing once daily. This was further supported by the patients plaque scores at 5% and bleeding scores at 4% with only minimal supra gingival calculus on lower anterior teeth. There was no erythema or oedema present on the gingival tissues.
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.
3. Nasojejunal (NJ) or Post pyloric: The feeding tube is placed in jejunum by passing the stomach. This prevents the risk of aspiration.
A hiatal hernia is usually detected using three methods, an upper endoscopy also called esophagogastroduodenoscopy or EGD, a plain chest radiograph, and and upper GI barium series (Kahn, 2008). When using an upper endoscopy to diagnose hiatal hernia, the doctor will insert a small, lighted, flexible tube called an endoscope into the patient's mouth. The endoscope will allow the examination of the stomach, esophagus, and the duodenum including the soft tissues and walls of the upper digestive tract (Gillson, 2008). The patient is typically advised to not to eat anything for at least six hours prior to the procedure. The patient is given a sedative to help them relax and a local anesthetic is sprayed into their throat to suppress any gag reflex they might fe...