INSTRUCTIONS: Read the following reports and correct all errors....

Question Answered step-by-step INSTRUCTIONS: Read the following reports and correct all errors…. INSTRUCTIONS: Read the following reports and correct all errors. There are 49 all together. Check for spelling first, then content to make sure it all makes sense. Follow the story and if something doesn’t make sense, it probably needs corrected. Utilize your researching skills to fix the errors. CONSULTATIONIMPRESION: 1. Possible leek at cystic duct.2. Rule out common bowel duct stone. RECOMMENDATION: ERCD with stent placement, possible sphincterotomy for removal of the stone. Procedure, risks, benefits, alternatives discussed – 5% risk of pancreatitis, 1% risk of bleeding, perforation, sepsus, etc., werediscussed with patient and family. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ HISTORY OF PERSISTENT ILLNESS: The patient is a pleasant 78-year-old male who apparently had apancreatitis thought to be biliary and underwent colecystectomy by Dr. Weber. During the procedure he felt that the cystic duct was large and irregular. The intraoperative cholangogram was carried out which showed mild irregularity of the distal common bile duct with mild prominence of the biliary system. No defenite filling defect was noted. On 4/02/07 patient continued to have a lot of drainage around Johnson-Pratt drain site and as drainage continued Dr. Weber felt that suture placed around the drain sight may have slipped.Patient denied any nausea, vomiting, dysphasia, or heartburn. He does have vague abdominal discomfort in the right supper quadrant and epigastric area. No diarrhea or constipation. No fever, chills, hematochezia,melena, etc. He had a white count done today of 15.6 with segs of 79.1, nutrophils 12.3, hemoglobin and hemacrit normal. Platelets 561. Alkaline phosphatase 289, SGOT 63, SGPT 58, bilirubin 1.8 with direct of 1.1. ALLERGIES: NONE KNOWN. MEDACATIONS: Triamterene, metoprolol, levothyroxine, Tylenol #3 p.r.n. FAMILY HISTORY: Mother deceased at age 80 with aneurysm. Father deceased at age 65 with liver CA. One sister healthy and lives in Florida. No history of colon cancer or polyp. PAST MEDICAL HISTORY/ PAST SURGICAL HISTORY: Hypertension, arthritis, thyroid disease, colecystectomy, right total knee orthroscopy, no problem with sedation or analgesia. SOCIAL HISTORY: No smoking. Social alcohol. No drugs. He is married. Two children. Retired. REVIEW OF SYSTEMS: Anorexia and general body weakness. She has shortness of breath, difficulty walking, pour hearing, muscle weakness, and arthritis. PHISICAL EXAMINATION: GENERAL: The patient is alert, oriented, conscious and coherent in no apparent acute distress.VITAL SIGNS: Vital signs are reveiwed and they are stabel. HEENT: Normalcephalic, nonicteric sclera.NECK: Supple. No nukal rigidity.LUNGS: Clear to oscultation and percussion. HEART: Regular rhythm. No S1, S2. Normal S3, S4. ABDOMEN: Soft. Mild tenderness. This is the surgical sight. JP site draining bile, covered with dressing and a bag.EXTRIMITIES: No petal edema. Deep tendin reflexes are normal. NEUROLOGIC: Grossly normal. LABORATORIES: As mentioned above. Thank you for this consultation. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ OPERATIVE NOTE PREOPERATIVE DIAGNOSIS: Biliary drainage, excessive drippy drain site. POSTOPERATIVE DIAGNOSIS: 1. Leek at cystic duck site. 2. No stones in the common bile duct. 3. Gastric ulcer. SURGEON: Dr. Sheth ASSISTANT: Dawn and Towanda. MEDICATION: Per anesthesia. PROCEDURE: 1. Endoscopic retrograde cholangiopancreatography.2. Endoscopic biliary stent placement.3. Biopsy of stomach for CLO test. INDICATION: Patient is a 78-year-old male with a history of pancreatitis who underwent cholecystectomy. A JP drain was placed. After that, an accessive amount of bowel being noted coming out of the drain. DESCRIPTION: Informed consent obtained. A 5% risk of pancreatitis, 1% risk of bleeding, purforation, and sepses individually were discussed with patient. After this, he was brought to the endoscopy lab and placed in an endoscopic retrograde cholangiopancreatography position. The throat was already numbedwith anesthetic gargle. A flexible fiberoptic Olympis video side-wing duodenoscopy was inserted into the esophagus without any difficulty and gradually advanced threw the pharynx, into the esophagus, stomach, and duodenem. The ampulla was visualized. It was draining nicely. There was some bilein the stomach. A gastric ulcer, 1 cm size, was noted. It was very difficult to be evaluated because of the inability to distend significantly. A RX system with a catheter was threaded toward the ampulla. A guide wire was advanced. Initially it went into the PD a couple of times and then after changing the position several times, it went into the common bile duct. No die was injected into the pancretic duct. Catheter was advanced, die was injected, pictures were observed of the comon bile duct. It appearedthat a lot of dye around the cystic duct site suggesting leak over there. This did not move. Finally, a 7 French 7 cm size endobiliary stint was deployed. It was draining nicely. While withdrawing, we obtained a biopsy from incisura and antrum for CLO test. Scope was withdrawn. RECOMMENDATION:1. Observe the patient.2. Follow-up labs.3. Follow-up gastral ulcer. Health Science Science Nursing Hit 244 Share QuestionEmailCopy link Comments (0)