Gastronomy Jejunostomy Tube Exchange: Case Study

He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy.

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

Diagnostic Studies: Flat plate and upright films of the abdomen revealed a localized abnormal gas pattern in the right lower quadrant with no evidence of free air.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

There seem to be an increasing application of Roen-en-Y gastric bypass today by some surgeons. This is a restrictive procedure that has minimal mal-absorption issues and it makes part of an array of bariatric surgeries. However, the most commonly used procedure is biliopancreatic diversion or Scopinaro, which have been used for more than two decades and are popular in with many surgeons more so in the developing countries. This process is intended to inhibit absorption of fat in a bid to trigger massive weight loss in patients who are morbidly obese. It restricts gastric thereby diverting bile and pancreatic fluids to the distal ileum (Consensus Development Conference Panel, 1991). This procedure therefore exposes a limited area of small bowel for the absorption of nutrients that need biliary and pancreatic fluids. The procedure and its variations are still common as indicated above including; biliopancreatic diversion with duodenal switch, which also result in malabsorption. It is however noted that most patients who undergo this procedure also experience severe protein and fat related malabsorption problems.

Mindy Perkins is 48 year old woman who presents to the ED with 10- 15 loose, liquid stools daily for the past 2 days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition to loose stools, she complains of lower abdominal pain that began 2 days ago as well. She has not noted any blood in the stool. She denies vomiting, fever, or chills. She is on Prednisone for Crohn’s disease as well as Pantoprazole (Protonix) for severe GERD.

B.S. is an 81 year old Caucasian female presenting with abdominal pain, diarrhea, nausea and vomiting in the emergency room on February 3, 2013. B.S. has a history of glaucoma, hypothyroidism, degenerative arthritis and diverticulosis. She has allergies to iodine and vicodin. B.S. is admitted for diverticulitis with possible partial bowel obstruction and hydronephrosis. B.S. was admitted on February 3, 2013 here at Verdugo Hills Hospital.

The patient is a 45 year old man who had GI surgery 4 days ago.  He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr.  The nursing physical assessment includes the following:  alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours.  Voiding dark amber urine without difficulty.  Intake for last 24 hours is 2500mL.  Output is 2000mL including urine and NG drainage.  Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum

Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be prompted by the MO. Although with more practice such incidence would be reduced.

DS is a 57-year-old white female whit a history of diverticulitis who presents to the clinic for an evaluation of abdominal pain. She stated that she began experiencing left lower quadrant pain last night that worsened through the night and into this morning. The pain is described as dull, occasionally cramping, rated 7/10 in severity. The patient also stated that this pain is similar to previous episodes of diverticulitis. The patient stated that she took Gas-X this morning with little relief. She was able to move her bowels yesterday and this morning, both reportedly normal. The patient denied any fever, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, melena, hematochezia, or any other symptoms. At this time, there were

Under the general anesthetic condition, endoscopic was obtained in order to define characteristic of dehiscence and confirm diagnosis in case of high index of suspicion but a negative finding from other investigation. Degree of Necrosis, percentage of dehiscence, the size of anastomotic gap, cavity and location were recorded. The cause of dehiscence was classified based on origin as gastric conduit necrosis, conduit staple line dehiscence and anastomotic dehiscence. The endoscopic options have chosen was largely based on endoscopic specialist prefer. Drainage and debridement the infected area was performed during endoscopic treatment or prior endoscopy intend to control of sepsis and adequate drainage of infection. After identifying dehiscence site by injecting water-soluble contrast and real time fluoroscopy, we elect to place stent in all patients for diversion therapy. The metallic stent was placed over the guide wire to deploy with fluoroscopic guidance transverse to dehiscence site. After stent placement, water-soluble was injected through the lumen to confirm effective seal disruption. Type and size of stents were chosen by the endoscopist base on suitable for the patient. Some case used salivary stent(fig.1) and was placed under direct vision and secure to nasal septum using umbilical tape for preventing migration. Feeding was started with liquid after dehiscence was occlusion and supplement with other route for full nutritional support. For Stent surveillance, we will do Chest x-ray q 1-2 days to evaluate severe concomitant condition, also assess possible stent migration, and the need for reposition stent by repeated endoscopic while in hospital if patient discharge, we make an appointment for chest x-ray q 1-2 weeks. The patients underwent endoscopic for exchange stent or subsequent appropriate endoscopic therapy in 4-6

Nasogastric tubes are placed after a surgical procedure, ie. whipples, puestows, and gastrectomies, to decompress the stomach or small bowel (Snaith & Flintham, 2014). These tubes are blindly inserted in the operating room normally by anesthesia once the surgery is complete. By definition, a blindly inserted nasogastric tube is one inserted without the use of imaging guidance, including fluoroscopy or ultrasound. The two most common complications of blindly guided tubes are insertion in the lungs and inaccurate placement in the esophagus. On rare occasions, nasogastric tubes have been lodged in the brain or spinal cord. As a result, x-ray verification has been considered to be the gold standard

Healthy 22-year-old female was post-operative day 2 with open appendectomy. Her height is 5 feet and 7 ins, as well as her weight is 135 lbs. BMI is within normal range. She does not have weight gain or loss, fatigue, malaise, weakness, sweats, night sweats or chills. She had right lower quadrant abdominal pain and came to urgent care due to she could not tolerate the pain and she could not get the appointment to visit her primary care physician. Her abdominal and pelvic CT (computed tomography) revealed acute appendicitis and open appendectomy was performed at the same

* Most commonly used for access to the right colon, duodenum, access to the pancreas where the incision is carried across the midline