Here it is

case presentation

On September 20,2013 a ambulatory patient 82 years of age is walked into a fluoroscopy room accompanied by his son. The procedure, its risks and benefits were explained thoroughly and consent was signed to commence the exam. On september 19, 2013, the day prior, a CT scan of the abdomen/pelvis and a sonogram of the abdomen were taken. Results showed that the gallbladder appears to be distended with thickening of the wall suspicious for acute cholecystitis.

Cholecystitis is inflammation of the gallbladder. ¬†Referring to “http://biology.about.com/library/organs/bldigestliver3.htm” The function of the gallbladder is to store and excrete bile, however if the gallbladder is inflamed then bile cannot travel out of the gallbladder. Cholecystitis can be caused by numerous pathology such as infection or trauma, but the most often occurrence is the cystic duct is blocked by a gallstone which causes the gallbladder to become irritated and swollen. Major signs of cholecystitis are pain in the right upper abdomen, fever and increasing pain after taking in deep breaths. To diagnose cholecystitis your doctor will first perform a physical exam to check for tenderness. He/she may ask for blood to be drawn to run for tests. Otherwise a CT scan or ultrasound will be performed to check for gallstones or buildup of fluid. The size and shape of the gallbladder is another important factor in diagnosing cholecystitis.
The patient was placed in supine position on the CT table, consciously sedated with 50 mcg of fentanyl, a lightly sedating narcotic, intravenously by the interventional radiology nurse. The patient was also administered 1 mg of Versed which is a drug derivative of midazolam which induces a drowsy and calm feeling throughout the exam.  Vital signs were closely monitored throughout the procedure and the CT of the abdomen was obtained. According to Igor Fishkin MD, CT results re-demonstrated a distended gallbladder with thickening of the walls.
Following the CT exam, with reoccurring results it was time for a CT guided percutaneous cholecystostomy and ¬†sample of fluid from the gallbladder to be sent to the lab. In a normal cholecystostomy according to “http://radiopaedia.org/articles/percutaneous-cholecystostomythe” the gallbladder is punctured with an 18 or 19 gauge needle under ultrasound guidance. Bile can then be aspirated for microbiological studies. A 0.035 guidewire is used to exchange the needle for a dilator and an 8 French or larger pigtail drain is placed within the gallbladder. The drain can often be visualised under ultrasound. Aspiration of bile/pus from the drain confirms satisfactory position.
According to the report by Doctor Fishkin .MD “A safe spot for needle insertion was chosen and marked on the skin. The right upper quadrant of the abdomen was prepped and draped in the usual sterile fashion.” Equipment that was used for this fluid extraction was a 5 French micro-puncture set and an 8 french APD(all-purpose draining) catheter. Approximately 300 cc’s of a cloudy greenish fluid were aspirated out of said catheter. A sample of this fluid will be sent to the laboratory for study and future diagnosis.
Post Cholecystosmy, typically 2-4 hours of bed rest with regular monitoring of vital signs is routinely done. Catheter is flushed and aspirated regularly with saline 6 to 8 hours after exam. A cholecystogram which is an injection of contrast through fluoroscopy is performed when the patient is stable. This procedure is to done to help establish satisfactory catheter position and the state of the gallbladder. It also allows assessment of any residual calculi in the biliary tree. The catheter can be removed once the tract is mature (usually 3-4 weeks). A trial of clamping the catheter for 24 hours is usually done prior to removing the catheter.
Pending results of laboratory studies, if the patient is diagnosed with Cholecystitis, he will need to undergo a procedure called a cholecystectomy. A cholecystectomy is the removal of the gallbladder by surgery.  Sometimes the physician may need to reduce the swelling of the gallbladder before attempting to remove it.  To perform a Laparoscopic cholecystectomy, a small camera is inserted through one of three to four incisions in the abdomen.  The doctor will use air or carbon dioxide to inflate the patient’s stomach in order to have a clear view of the surgical instruments and the gallbladder and have a clean removal through one of the incisions.  Post-surgery, the liver will produce bile and transport it to the small intestine through the common bile duct it just won’t be stored in the gallbladder.  On average it will only take one week to fully recover from Laparoscopic Cholecystectomy surgery.

Powerpoint Presentation

Okay guys here it is, ive uploaded a link to the powerpoint presentation, let me now your thoughts, comments and suggestions. I feel it may be to long, but wasnt sure what to cut out. I suggest reviewing it under slide show because theres 1 or 2 animations that ive added

Not sure which one to go with, animations are a bit different.

1.ICSPPT R

2.ICSPPT R2

The Paper

Ok guys i have completed a rough draft of the paper, all i have to do is Cite the sources and use proper formatting techniques. I am going to bring in a copy of the paper into school and have you guys making any editing desires you wish to make. Thank you everyone who posted information relative to our project and thank you Michael and Giuseppe for being great teammates in the paper writing process and for being patient with me. The final draft will be completed after you all have had your input takin into account

Thank you

Body Paragraphs (please review and make corrections if you see them)

Body:

Cholecytitis is inflammation of the gallbladder.  The function of the gallbladder is to store and excrete bile, however if the gallbladder is inflamed then bile cannot travel out of the gallbladder.  Cholecytitis can be caused by numerous pathologies such as infection or trauma. Most often the occurrence is caused by the cystic duct being blocked by a gallstone which in turn causes the gallbladder to become irritated and swollen.  The major signs of cholecytitis are pain in the right upper abdomen, fever and increasing pain after taking in deep breaths.  To diagnose cholecysitits your doctor will first perform a physical exam to check for tenderness.  He or she may ask for blood to be drawn to run for tests.  Otherwise a CT scan or ultrasound will be performed to check for gallstones or buildup of fluid.  The size and shape of the gallbladder is another important factor in diagnosing cholecystitis.

The main procedure for cholecystits is a cholecystectomy, the removal of the gallbladder by surgery.  Sometimes the physician may need to reduce the swelling of the gallbladder before attempting to remove it.  To perform a Laparoscopic cholecystectomy, a small camera is inserted through one of three to four incisions in the abdomen.  The doctor will use air or carbon dioxide to inflate the patient’s stomach in order to have a clear view of the surgical instruments and the gallbladder and have a clean removal through one of the incisions.  Post-surgery, the liver will produce bile and transport it to the small intestine through the common bile duct it just won’t be stored in the gallbladder.  On average it will only take one week to fully recover from a Laparoscopic Cholecystectomy surgery.

Progress On Essay

Mike and I are doing great progress on the paper.

So far what we have:
  Intro
  Gallbladder Anatomy
  Gallbladder Disease (Cholecystitis)
  Gallbladder Treatments

Whats left to do:
  Patients Previous And Upcoming Exams
  Diagnosis Of Patient
  Final Report Of Patients Progress

Powerpoint Presentation Due October 9th

Hey Guys & Gals,
I’m putting together the powerpoint presentation Professor Vinokur requested. I need you all to either post your names here or email me them so I could get the spelling correct. Thanks ūüôā

Okay, so heres the Powerpoint Slides I put together, if any one has any comments, suggestions or ideas, let me know by Sunday night and i’ll try to incorporate them, otherwise ill go ahead and email this version to Professor Vinokur.

Interhospital Case Study PPT Poster Version