PEG Tract Infection

HISTORY OF PRESENT ILLNESS: Patient is a candidate for a total right hip revision. She has 2 units of directed packed red blood cells. It is not autologous. She does had Hepatitis B. She has arthrogryposis. She had a right total hip replacement many years ago by Dr. Dodd at the University of Miami. She has had multiple other surgical procedures as follows. A: She had bilateral foot surgery In the remote past. B: She had left hip surgery a year ago. C: She had right foot

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

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)

A week after initial admission, the patient is on the medical surgical floor recovering from his transverse colostomy five days ago. At 1200 vital signs are as follows, temperature 99.1; pulse 96; respirations 18; blood pressure 141/69; pulse ox is 94% on 1L NC in AM. The patient appears acutely ill and lays in bed with his eyes closed even when family comes into the room to check on him. He is alert and oriented to person, but not place or situation. He appears lethargic and is slow to respond to questioning, this appears to be due to recent administration of pain medication. Pupils are equal round and reactive to light and grips are week bilaterally in hands. Abdomen is firm, distended, and non-tender. Colostomy site appears to be

The patient is a 41-year-old gentleman who was recently discharged from the hospital 2 days ago. He presented back to the ED complaining of nausea, vomiting, abdominal pain and he presented here instead of going to his regularly scheduled hemodialysis. He also stated that he thought he had blood in his stools. He was also complaining of abdominal pain and constipation and requesting IV Dilaudid and IV Benadryl. CAT scan of the abdomen showed wall thickening around the rectum and distal sigmoid, procto-colitis was not excluded. Initially the attending physician has hoped to keep the patient in outpatient status, however he was admitted inpatient. The case was discussed with Dr. Lasheen, it was decided in view of his multiplicity of comorbidities

On 10/13/16 I met Mr. Westover at the office of Dr. Raymond. Mr. Westover ambulates with a cane. He reports when he is at home he doesn’t use it. Physical therapy continues to work with strength and balance goals. Mr. Westover feels he would benefit with another month of therapy. He has completed speech therapy. The peg tube site on Mr. Westover’s abdomen still has a scab and scant drainage at times. Dr. Raymond would like his to keep putting Neosporin on it. If it doesn’t fully close doctor would like him to follow up with gastrologist who put the tube in. Mr. Westover examination shows weakness still on the left leg, and right arm.

Ghrelin, commonly referred to as the “hunger hormone,” is a 28-amino acid peptide that has many important roles in human digestion including regulation of growth hormone release, enhancement of appetite, and increase of food intake (1). This gut-derived peptide could play an extremely important role in the altered eating behaviors of patients with eating disorders. Increased fasting plasma ghrelin levels have been consistently reported in underweight patients with anorexia nervosa. Circulating levels of this hormone have also been found to be enhanced in symptomatic bulimic patients, while also being blunted in response to balanced meals (4).

He was admitted to the ICU because he had surgery to redone his stoma He was intubated because of respiratory failure after his abdominal surgery. his condition is very critical because the fluid from his wound vac and colostomy is dark red and patient is in distress. He was on constant monitoring for a change in his

"St. Michael the Archangel" For my saint, I picked Saint Michael the Archangel. I picked St. Michael because Michael is my middle name. Saint Michael is a name meaning "He who is like God" in Hebrew. He is said to be placed over all the angels. He is the Patron Saint of soldiers, security guards, and sick people. Saint Michael is one of the seven archangels, him being one of the three mention in the Bible. He is the leader of the army of God during the Lucifer upraising. It is said by Pope Gregory the Great "Whenever some act of wondrous power must be performed, Michael is sent, so that his action and his name may make it clear that no one can do what God does by his superior power." Saint Michael is one of the principal angels. In Latin,

Ms. Huttunen works washing cars. While washing the top of a car she twisted wrong, when she stepped back she felt pain in her right leg. The pain is to her low back with radiation down the right leg to the ankle. After she finished her shift she went to the McLaren hospital. They gave her a steroid injection and kept her off work for 5 days. After resting taking medications as directed she returned to the emergency room at McLaren hospital on 4/8/16. She was told to see her primary care doctor. She then went to Sparrow hospital about 4/12/16. She reported she could not

The patient is a 59-year-old gentleman who is a resident of Lincoln Park nursing home on hemodialysis end-stage renal disease, has multiplicity of medical problems including diabetes, hypertension, afib, anxiety, either schizophrenia and/or bipolar disease, coronary artery disease, peripheral vascular disease, had a below the knee amputation in 2015. The patient was referred to the ER from the Lincoln Park nursing home because of an ulcerated lesion on his left upper anterior chest over where a porta cath resided. My clinical review of his chart determines that the patient had no fever, no white count, no induration or erythema. He simply had an ulcerated lesion and the porta cath needed to be removed which was done by interventional radiology,

At today's visit, I am here to follow up for his functional decline. The patient is nonverbal, lying in bed. He is unable to express his needs. The patient affects appears brighter today. The patient’s wife reports that the continue to decline functional. He is now pocketing his food and medications in his mouth. She states that his hypotension, shortness of breath and congestion has improved. The wife reports that she was notified by the wound care center that the patient’s wound culture was positive for bacteria. He is schedule to start Bactrim DS antibiotic. He remains

The patient had been admitted 13 days prior to when I began caring for her with an acute flare up of pancreatitis. In 2013 she was diagnosed with pancreatitis caused by gallstones with a pseudocyst. She had a history of the pseudocyst being drained, the most recent time being in July of 2016. At that time, the doctor drained three liters of fluid from

Patient CB is a 36 year old African American Female. She has a past medical history of hypertension, acid reflux, heartburn, and a hernia repair one year ago. She is a nonsmoker and reports never taking recreational drugs. Diagnostic tests related to her diagnosis include an abdominal ultrasound showing gallstones, an x-ray to verify stone presence, and tenderness with touch on the abdomin. CB was having a cholecystectomy because she was having pain in her abdomen related to gallstones. Her hernia was a result of a weakening of the abdominal wall.

Dr. Patel claimed that the patient’s heart rate was little bit higher than usual. The patient was put to sleep and we watched the heart rate slowly decrease. The heart rate was lowered, but was still kind of faster than it should have been. The bed was raised and Dr. Patel laid the patient onto their left side and strapped them down patient. Iodine was applied to the patient and prepared for surgery. Dr. Cefali made an incision on the patient and began opening few wounds to allow an endoscope along with some other tools. Dr. Cefali made another incision near the right