Minimal Access Surgery Case Study

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

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.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

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

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

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

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

PAST MEDICAL/SURGICAL HISTORY: As above. SOCIAL HISTORY: Status post heavy smoking, 50+-pack-year history. He quit 10 years ago. Status post alcohol abuse, quit 3 or 4 years ago. He lives by himself and no longer drives but has 2 daughters here in Miami who take him where he needs to go. FAMILY HISTORY: Patient’s wife died 14 years ago of COPD due to lifelong smoking. Brother has diabetes mellitus. Unremarkable family history otherwise. REVIEW OF SYSTEMS: No fever, no nausea, no vomiting. Patient has incontinence of bowel. No shortness of breath, no chest pain, no palpitations. PHYSICAL EXAMINATION: Well-developed, well-nourished white male who is alert and oriented x3. Wears bilateral hearing aids. Afebrile with blood pressure 130/70. NECK: No carotid bruits. LUNGS: Clear to auscultation bilaterally. HEART: S1, S2 normal. No murmur. No S3 or S4. ABDOMEN: Soft, nontender. No arterial bruits. No masses, no organomegaly. EXTREMITIES: No edema. No pulses present in the lower extremities. The right great toe is absent. The left great toe shows a 2 x 1 cm deep ulcer with redness around the toe with pus extruding. PLAN 1. Get consult with Dr. Beth Brian, Infectious Disease. 2. Follow up with Dr. Hirsch, Orthopedics. (Continued)

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure

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

The patient is a 44-year-old female who I saw for her physical in June 18, 2015. At that point, she was complaining of epigastric pain that radiated into her back. I did ask her to start Prilosec over the counter, daily. Initially, we had called her and she reported that this was helpful, although now, she reports that at the same time, she had a cold and she was more focused on the cold than the epigastric pain. Subsequently, she states her pain really has not changed and she continues to have epigastric pain, which does radiate to her mid-back. Her bowel movements have been soft, she has been somewhat nauseous, but no vomiting. She has not see any blood in her stools. She does think

History: A 67-year-old Caucasian male with a past medical history of type 2 diabetes mellitus and osteoarthritis presented to the ED with complaints of dark stools for three days associated with lightheadedness.He reported inability to maintain his usual schedule due to fatigue. He also reported his stools to appear darker than usual with a sticky texture and a malodorous smell. He described a recent worsening in intensity of a long-standing epigastric burning sensation which has been occurring intermittently for years. He denied any significant relief with doubling the usual dose of Tums during this time. He denied any associated chest pain, palpitations, dyspnea or syncopal episode. His current medications include metformin 500 mg twice a

Upper GI tract obstruction Tanaka et al. [8]reported that in 19 of the 29 patients, in whom HCC involved directly the upper GI tract; initial endoscopic assessment revealed an ulcerative hemorrhagic tumor protruding into the lumen of the stomach or duodenum [9], in most of these cases were very advanced HCCs like in our case.

A 64-year-old female comes to the clinic complaining of a newly formed ulcer over her upper chest. She states that it has been increasing in size over the last few months. She has tried treating it with several over the counter antibiotic creams, with no success. She denies that it is itchy but says at times it will bleed, especially when she picks at it or rubs it. She had a spider bite in the exact same area of the ulcer several years ago, which left a small scar that never quite healed over in time. She denies any other ulcers on other parts of her body. The review of systems is negative, especially for fevers, chills, fatigue, appetite changes, or weight loss. She has a past medical history of follicular cell carcinoma of the thyroid,