Normal ampulla .
Common bile duct cannulation was performed using a Olympus sphincterotome .
Cholangiogram showed distal filling defects.
Sphincterotomy performed to 9 mm.
All stones extracted with Olympus balloon; [].
Normal occlusion cholangiogram at the end of the procedure. CPT Codes - 43261,43262,43264 in 2018
Reply to this Note | Notes Linking Here | http://medical.olympusamerica.com/products/clevercut2v-and-3v-sphincterotomes | Prior Note
Hbeag positive patients. Treat for DNA > 20k and alt greater than 2x normal. Hbv related poly arteritis nodosa.
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Autoimmune hepatitis presents with ast and alt elevations greater than fifteen times upper limit of normal. Check spep, then check ana and anti smooth muscle antibody.
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Carcinoid - types I and II: elevated gastrin levels, significantly lower malignancy potential, no intervention is needed if they are less than 1 cm in size. Type III gastric carcinoids: sporadic, absence of atrophic gastritis or gastrinoma. Fasting serum gastrin level: normal in type III gastric carcinoid tumor patients.
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1. Pancreatitis - normal saline IVF at 200 cc/hr. Patient counseled on low-fat diet on discharge and avoiding alcohol as this can precipitate pancreatitis. Optimum diabetes management to avoid hypertriglyceridemia.
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" 50 or 100 U of
the lyophilized powder. The powder is diluted in 5 mL of
normal saline to yield a solution containing 20-25 U/mL.
After diagnostic upper endoscopy, the pyloric sphincter
area is identified, and a sclerotherapy needle (23 or
25 gauge) is introduced thr
ough the biopsy channel.
Aliquots of 1-1.5 mL (20-25 U botulinum toxin/mL) are
injected into each of four quadrants of the pylorus, for a
t
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International Normalized Ratio Does Not Predict Gastrointestinal Bleeding After Endoscopic Retrograde Cholangiopancreatography in Patients With Cirrhosis
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Gastroenterology will sign off. Please call with questions. Can follow up with me in 2-4 weeks to check normalization of CMP as an outpatient.
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Normal ampulla .
Common bile duct cannulation was performed using a Olympus sphincterotome .
Cholangiogram showed distal filling defects.
Sphincterotomy performed to 9 mm.
All stones extracted with Olympus balloon; [].
Normal occlusion cholangiogram at the end of the procedure. CPT Codes - 43261,43262,43264 in 2018
...Read more
Esophagogastroduodenoscopy with variceal banding and control of hemorrhage. Esogphagus - Grade 2 esophageal varices with stigmata of recent bleeding including cherry red spots. Banded times three with eradication of varices. Bleeding from the varices during the procedure had stopped at the end of the procedure. Esophagus was otherwise normal.
Gastritis with edema and portal hypertensive gastropathy in the antrum, body, and fundus.
Duodenum was normal.
Propranolol 10 mg PO BID on discharge titrated by heartrate. Octreotide drip for three days. Clear liquid diet today, soft diet tomorrow, then resume low sodium diet the next day barring complications. The patient needs to follow up with gastroenterology to discuss repeat EGD in 2 weeks. Message was sent to clinic for follow up. Bleeding source was esophageal varices.
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Normal physical exam template for Meditech or Medhost.
- GENERAL: Not in acute distress
- HEENT: Moist mucous membranes
- NECK: Supple.
- PULMONARY: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
- CARDIOVASCULAR SYSTEM: Positive S1 and S2. No murmurs, gallops, or rubs.
- ABDOMEN: soft, non-tender, positive bowel sounds.
- EXTREMITIES: No clubbing, cyanosis, or edema.
- PSYCHIATRIC: Pleasant and cooperative
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