Medical Specialties Commons^™

Availability Of Pain Medications For Npo Patients, Anna Augustin Do, Kyle Borodunovich Do, Sean Quinonez Do, Furqan Haq, My Myers Md

Family Medicine

In recent years, the opioid epidemic has been a key catalyst in changing the medical standards for treating both acute and chronic pain. Instead of relying heavily on narcotics for pain management, practitioners are not encouraged to adapt a non-pharmacologic, non-opioid approach to analgesia. While many guidelines have been set to standardize outpatient pain management, the rules surrounding inpatient analgesia are limited or lacking.

Safe And Effective Use Of A Hands-Free Intracorporeal Retractor For Suture-Based Liver Retraction During Minimally Invasive Bariatric Procedures: Results Of A Large Case Series, Roger De La Torre, Matthew Sappington, Tom Smith, Jeremy Bryner, David Mantilla, J Stephen Scott

General Surgery

Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure.

Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 …

Incidence Of Aspirin Effect In An Anticipated Aspirin Negative Elderly Population, Emily Gullette, Heather Rhodes Md, Brant Clatterbuck Md, Nayda Parisio Poldiak, Christoph Kaufmann

General Surgery

No abstract provided.

Prevalence Of Methicillin Resistant Staph Aureus Over Time In Resident Physicians, Lexus Dickson, Morgan Smith Md, Scott Gutovitz, Danielle Kocsis, Jean B. Wiggins, Steve Warrington Md, Stephen Thacker Md, Nayda Parisio Poldiak

Emergency Medicine

No abstract provided.

A Novel Polyelectrolyte Multilayer Nanofilm-Based Synthetic Bioresorbable Antimicrobial Matrix Accelerated Healing Of Chronic Wounds In A Prospective Clinical Evaluation, Sarah Waterman Manning Md, David A. Humphrey, Michael J. Schurr, Eric C. Crawford, Gaurav Pranami, William Shillinglaw, Lorinda K. Baker, Michael J. Schurr

General Surgery

No abstract provided.

Bone Metastasis In Appendicular Skeleton: Rare Occurrence In Colorectal Cancer, Pratikkumar Vekaria Md, Chandrika Raiyani Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Gastroenterology

Colorectal cancer (CRC) is considered as preventable cancer if diagnosed in the early stage. It is also second leading cause of death from cancer in US. Bone metastases (BM) is uncommon presentation with CRC and if it occurs, it involves axial skeletal more than extremities. Many case studies also reports that survival after BM is considerably poor than without BM. Cancer type and genetic mutations also play an important role in such metastasis.

Gastroenterology, A Guiding Light In Hemophagocytic Lymphohistiocytosis, Sahityan Viswanathan, Jeffrey Capati, Long T. Hoang

Gastroenterology

No abstract provided.

Double Pylorus: Case Report Of Atypical Presentation, Christopher Lozano Orpiano Do, Gurjeet Kang Do, Michael Quinn Do, Lakshminarasimhan Venu Md, Joseph Staffetti Md

Gastroenterology

Introduction: Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies, consisting of a gastroduodenal fistula extending from the prepyloric gastric antrum to the duodenal bulb through an accessory channel. In the majority of cases, it is a complication when peptic ulcers erode and create a fistula between the duodenal bulb and the distal stomach. It usually presents on the lessor curvature of the gastric antrum and on a superior wall of the duodenal bulb. It is commonly an endoscopic finding, since clinical presentation is similar to other peptic diseases.

Case …

Salivary Gland Choristoma: A Rare Finding At Gastroesophageal Junction, Isin Y. Comba Md, Richard Henriquez Md, Sundeep Kumar Md, Hilda Merino-Chavez Md, Maria Wallis-Crespo Md, Christopher Cooper Md, Lakhinder Bhatia Md

Gastroenterology

Introduction: Choristoma is tumor-like outgrowth of heterotopic and mature tissue located at anatomically unusual sites. Heterotopic salivary gland tissue (HSGT) has been most commonly described in head and neck region but can rarely involve gastrointestinal (GI) tract with a few cases reported in the literature.

Case Description/Methods: An 87-year-old female with past medical history of gastroesophageal reflux disease (GERD), hypertension, and chronic kidney disease was admitted for an acute DVT. Due to worsening anemia, she underwent an upper endoscopy that showed a small nodularity at the GE junction (figure 1a), a large hiatal hernia, and reflux esophagitis in the lower …

Rare Obscure Cause Of Upper Gastrointestinal Bleeding: Bleeding Duodenal Lymphangiectasia, Sufian Sorathia, Rulz Cantave, Vivek Choksi, Kairavee D. Dave, Steven Kaplan

Gastroenterology

Introduction: While ulcerative and erosive mucosal changes are more commonly the culprit lesion of upper gastrointestinal bleeding, bleeding can also occur from traumatic, malignant or vascular lesions. An unusual and infrequent vascular cause of bleeding is from a focal intestinal lymphangiectasia (IL). We describe a patient who presented with bleeding from a duodenal IL.

Case Description/Methods: A 94-year-old female was sent by her nursing home for witnessed melena and new onset normocytic anemia with a hemoglobin of 7 g/dl. She was unable to provide a reliable history due to her advanced dementia. Her medical history was unknown. She was hypotensive …

Extracapsular Hepatocellular Adenoma: A Diagnostic Dilemma, Iisin Y. Comba, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Olga Karasik, Lakhinder Bhatia, Dong Xu

Gastroenterology

Introduction: Hepatocellular adenoma (HCA) is a benign tumor of the liver and almost always located intracapsular. Bleeding (25%), and malignant transformation (5%) can complicate the disease course if left untreated. Herein, we present a case of extracapsular HCA of ectopic liver in the omentum complicated with intraperitoneal hemorrhage.

Case Description/Methods: A 43-year-old lady with no past medical history presented to emergency department with two-day history of left shoulder pain and epigastric discomfort. Her only medication was an oral contraceptive pill (OCP). On physical exam, the patient had persistent sinus tachycardia, and epigastric tenderness. Initial labs were unremarkable except for mildly …

A Case Of Transient Complete Av Block Caused By Infective Endocarditis With Abiotrophiadefectiva, Jung Yoon Do, Wilco Civil Sr, Urvish Patel, Jermaine Ekobena, Arun Abraham, Michael Strobbe

Internal Medicine

No abstract provided.

A Scary Case Of Gastroenteritis, Kairavee D. Dave, Vivek Choksi, Sufian Sorathia, Rulz Cantave, Steven Kaplan

Gastroenterology

No abstract provided.

Size Matters: A Case Of Recurrent Proximal Esophageal Stenoses Treated With A Biliary Self Expanding Metal Stent (Sems), Sahityan Viswanathan, Timothy Dobin, Long T. Hoang

Gastroenterology

Esophageal stenosis after radiotherapy occurs in up to 15% of patients within three months of treatment. Endoscopic dilation remains the standard of care for cervical esophageal stenosis with refractory cases requiring stenting. Proximal stenosis poses a challenge as standard esophageal stents can cause cervicalgia and globus sensation due to their size and expansive force. We report on the usage of a biliary SEMS for a severe-recurrent stricture at the level of the proximal esophageal sphincter.

Not Just A Cyst: A Rare Presentation Of Luq Pain, Richard Henriquez, Isin Y. Comba Md, Sundeep Kumar Md, Khawaja Arsalan Bashir, Maria Wallis-Crespo Md, Lakhinder Bhatia Md

Gastroenterology

Lymphangioma is a benign congenital malformation of the lymphatic system that is relatively common in juvenile population. Rarely, it can be seen in adults and majority of the cases are reported in the head and neck region (70-75%). Typically, these malformations are asymptomatic. In this report, we present a rare case of splenic lymphangioma presenting with severe, intractable abdominal pain.

A Hiatal Hernia Causing Atrial Fibrillation Through Direct Mechanical Irritation, Kirolus Sourial, Zaid Yaqoob, Anthony Chahin, Saif Borgan, Ernesto S. Robalino Gonzaga, Aamir Javaid, Olga Karasik

Gastroenterology

Introduction: Hiatal hernia (HH) is anatomically classified into four types according to herniated structures. Giant HH refers to a herniation of > 50% of the stomach. Atrial fibrillation (AF) is a common arrhythmia, frequently seen in association with cardiovascular diseases. We report a case of AF caused by a giant HH compressing the left atrium.

Case Description/Methods: A 90+ year-old female with a past medical history of gastroesophageal reflux disease (GERD), was admitted for surgical evaluation of symptomatic HH. During hospital stay the patient developed AF with rapid ventricular response, became hypotensive and lightheaded. EKG (Figure 1) confirmed new onset AF …

Iron Pill-Induced Gastropathy In Elderly Patients: A Case Series Report, Isin Y. Comba Md, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Lakhinder Bhatia Md, Joshua Shultz

Gastroenterology

Introduction: Iron deficiency anemia is a global health problem with an estimated two billion cases worldwide. Oral iron supplementation is considered the first line treatment. However, recent studies favor the use of short-term IV iron especially in patients with drug tolerance and efficacy concerns. In this report, we present three cases of iron pill gastropathy in patient's whose clinical courses were complicated by gastric erosion, ulcer or gastrointestinal (GI) bleeding. All of our patients had a history of iron deficiency anemia and were being treated with oral ferrous sulfate.

Case Description/Methods: The first case involved a 72-year-old male with multiple …

Nasal Crohn's: Rare But Real Possibility, Pratikkumar Vekaria Md, Johnnie Mao Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Internal Medicine

Crohn’s disease(CD) is an autoimmune IBD that can occur anywhere along GI tract. Its pathology show transmural granulomatous inflammation that can include all layers of GI lining. Extra-intestinal manifestations can be seen in multiple organ systems like skin, joints, eyes, and mouth. These symptoms are common in patient involving large intestine compare to involving only small-intestine. Nasal involvement is rare with CD and very few cases have been reported so far.

Doxycycline-Induced Acute Pancreatitis: A Likely Source Rarely Seen, Paul Hoffman Do, Wilco Civil Sr, Jung Yoon Do, Gurjeet Kang Do, Christopher Lozano Orpiano Do, Michael Quinn Do, Joseph Staffetti Md, Dilip Ghanekar Md, Lakshminarasimhan Venu Md, Lily N. Jones Do, Ji Kwon Do, Shaival Thakore Md

Gastroenterology

No abstract provided.

A Unique Presentation Of Scurvy In The Modern Era, Anita Bhagavathula Do, Joanna Linsteadt Md, Sonam Jaggi Md

Internal Medicine

No abstract provided.

Pancreatic Cancer: Leading To Failure Of Rivaroxaban As An Anticoagulant, Pratikkumar Vekaria Md, Chandrika Raiyani, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

Vascular Thromboembolism (VTE) is seen with hypercoagulable state and it can be a reason of significant morbidity and mortality. Cancer is considered as one of the most common causes of hypercoagulability and developing VTE. Since novel oral anticoagulants (NOAC) have been introduced in market for VTE prophylaxis and treatment, their use have been increased significantly as they are easy to use without episodic monitoring. Rivaroxaban is one of the commonly used NOACs and some of studies have shown its good efficacy for VTE.

Point-Of-Care Ultrasound For The Pediatric Limp, Lucas Friedman Md

Pediatrics

Objectives

• Describe the technique and use of POCUS in the Limping Child
• Describe the use of POCUS in the diagnosis and treatment of Septic arthritis

Endoscopic Management Of A Surgical Clip Found Within The Common Bile Duct Following Remotely Performed Laparoscopic Cholecystectomy, Sheila Rastegari Do, Curtis Brewer Do, Long T. Hoang

Gastroenterology

Minimally invasive surgery with surgical clip placement has become the gold standard for management of cholecystitis and biliary colic due to its favorable safety profile and low rate of complications. Though generally safe, surgical clips may cause complications days to years after the cholecystectomy by migrating into the common bile duct and serving as a nidus for stone formation. To date, very few cases of this have been reported. While uncommon, this possibility should be considered in the differential diagnosis for choledocholithiasis with or without cholangitis post laparoscopic cholecystectomy.

Female Predominance In Metronidazole-Induced Acute Pancreatitis: A Case Report And Review Of Literature, Eileen Chang Do, Marvin Vaishnani Md, Ian Chang Do, Whitney Jennings Md

Internal Medicine

Acute pancreatitis is a relatively common condition in the hospital. About 75% of cases are associated with excessive alcohol use or gallstones, and only 0.1 to 2% are drug-induced. The clinical and pathologic findings are similar regardless of the inciting cause. We have suspicion that metronidazole-induced pancreatitis occurs at a significantly higher incidence, or maybe exclusively, in females.

Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md

Emergency Medicine

After an endothelial injury, a fibrin and platelet cap forms. This cap is typically sterile but in times of infection can become colonized by microbes leading to a vegetation. When this occurs on the endothelium of the heart, it is termed infective endocarditis (IE). IE is a difficult diagnosis to make in the ED. The symptoms are vague. Classic exam findings are often absent, murmur auscultation can be challenging and there is not a single diagnostic test. A delayed or missed diagnosis can be fatal; therefore, it is essential that ED physicians maintain a high index of suspicion in high …

Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md

Internal Medicine

•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2). The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3). Candida albicans and Candida glabrata are the two …

Rare Malignant Peritoneum Mesothelioma Masquerading With Respiratory Manifestation, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Chandrika Raiyani, Marvin Vaishnani, Tejas Raiyani

Internal Medicine

Mesothelioma is a rare and aggressive cancer that affects the linings of the pleura, peritoneum and pericardium. Pleural involvement is however most common. Malignant Peritoneal mesothelioma (MPM) is a cancer developing in the lining of the peritoneum, which is extremely rare. Most MPM cases are caused by asbestos exposure. Common symptoms of MPM include abdominal distension, abdominal pain, swelling or tenderness and constipation or diarrhea, with most common being abdominal swelling. MPM is difficult to diagnose due to its vague, nonspecific symptoms.

An Unusual Case Of Broken Heart, Ammar Hasan, Enrique Rincon

Cardiology

No abstract provided.

Non-Incarcerated Inguinal Hernia With Sigmoidal Diverticulitis, Umair J. Khan, Ali Hassan, Kingsley Dah, M Lambing, P Mathew

Internal Medicine

Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common …

Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon

Internal Medicine

No abstract provided.