Surgery 827 Sub-I Study Questions
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Focal Spot, Spring 2006
Washington University School of Medicine Digital Commons@Becker Focal Spot Archives Focal Spot Spring 2006 Focal Spot, Spring 2006 Follow this and additional works at: http://digitalcommons.wustl.edu/focal_spot_archives Recommended Citation Focal Spot, Spring 2006, April 2006. Bernard Becker Medical Library Archives. Washington University School of Medicine. This Book is brought to you for free and open access by the Focal Spot at Digital Commons@Becker. It has been accepted for inclusion in Focal Spot Archives by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. SPRING 2006 VOLUME 37, NUMBER 1 *eiN* i*^ MALLINCKRC RADIOLO AJIVERSITY *\ irtual Colonoscopy: a Lifesaving Technology ^.IIMi.|j|IUII'jd-H..l.i.|i|.llJ.lii|.|.M.; 3 2201 20C n « ■ m "■ ■ r. -1 -1 NTENTS FOCAL SPOT SPRING 2006 VOLUME 37, NUMBER 1 MIR: 75 YEARS OF RADIOLOGY EXPERIENCE In the early 1900s, radiology was considered by most medical practitioners as nothing more than photography. In this 75th year of Mallinckrodt Institute's existence, the first of a three-part series of articles will chronicle the rapid advancement of radiol- ogy at Washington University and the emergence of MIR as a world leader in the field of radiology. THE METABOLISM OF THE DIABETIC HEART More diabetic patients die from cardiovascular disease than from any other cause. Researchers in the Institute's Cardiovascular Imaging Laboratory are finding that the heart's metabolism may be one of the primary mechanisms by which diseases such as diabetes have a detrimental effect on heart function. VIRTUAL C0L0N0SC0PY: A LIFESAVING TECHNOLOGY More than 55,000 Americans die each year from cancers of the colon and rectum. -
High Resolution Anoscopy Overview
High Resolution Anoscopy Overview Naomi Jay, RN, NP, PhD University of California San Francisco Email: [email protected] Disclosures No Disclosures Definition of HRA Examination of the anus, anal canal and perianus using a colposcope with 5% acetic acid and Lugol’s solution. Basic Principles • Office-based procedure • Adapted from gynecologic colposcopy. • Validated for anal canal. • Similar terminology and descriptors. may be unfamiliar to non-gyn providers. • Comparable to vaginal and vulvar colposcopy. • Clinicians familiar with cervical colposcopy may be surprised by the difficult transition. Anal SCJ & AnTZ • Original vs. current SCJ less relevant. • TZ features less common, therefore more difficult to appreciate. • SCJ more subtle, difficult to see in entirety requires more manipulation & acetic acid. • Larger area of metaplastic changes overlying columnar epithelium compared to endocervix. • Most lesions found in the AnTZ. Atypical Metaplasia • Atypical metaplasia may indicate the presence of HSIL. • Radiate over distal rectum from SCJ. • Thin, may wipe off. • Features to look for indicating potential lesions: • Atypical clustered glands (ACG) • Lacy metaplastic borders (LM) • Epithelial Honeycombing (EH) Lugol’s. Staining • More utility in anus compared to cervix. • Adjunctive to help define borders, distinguish between possible LSIL/HSIL. • Most HSIL will be Lugol’s negative • LSIL may be Lugol’s partial or negative • Applied focally with small cotton swabs to better define an acetowhite lesion. •NOT a short cut to determine presence or absence of lesions, acetic acid is used first and is applied frequently. Anal vs. Cervical Characteristics • Punctation & Mosaic rarely “fine” mostly “coarse”. • Mosaic pattern mostly associated with HSIL. • Atypical vessels may be HSIL or cancer • Epithelial honeycombing & lacy metaplasia unique anal descriptors. -
Imaging in Double Gall Bladder with Acute Cholecystitis—A Rare Entity
Surgical Science, 2014, 5, 273-279 Published Online July 2014 in SciRes. http://www.scirp.org/journal/ss http://dx.doi.org/10.4236/ss.2014.57047 Imaging in Double Gall Bladder with Acute Cholecystitis—A Rare Entity Praveen Kumar Vasanthraj, Rajoo Ramachandran, Kumaresh Athiyappan, Anupama Chandrasekharan, Cunnigaiper Dhanasekaran Narayanan Department of Radiology, Sri Ramachandra University, Chennai, India Email: [email protected] Received 28 April 2014; revised 26 May 2014; accepted 22 June 2014 Copyright © 2014 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the man- agement and to avoid unnecessary bile duct injury during surgery. We report a case of duplicated gall bladder presenting as acute cholecystitis. Keywords Gall Bladder, Duplication, Cholecystitis 1. Introduction Gall bladder (GB) duplication is a rare congenital anomaly of hepatobiliary system with a reported incidence of about 1 per 4000 autopsies [1]. Duplication of gall bladder and their varying anatomical positions are associated with an increased risk of complications including biliary leak after laparoscopic or open cholecystectomy [2]-[5]. 2. Case Presentation A 45 years old lady presented with complaints of abdomen pain for the past two days. It was colicky type pain, intermittent in nature and localized to the right hypochondrium. She also gave history of three episodes of vo- miting which was non bilious, non blood stained and non foul smelling. -
Lower Gastrointestinal Tract
Lower Gastrointestinal Tract Hemorrhoids—Office Management and Review for Gastroenterologists Mitchel Guttenplan, MD, FACS 1 and Robert A Ganz, MD, FASGE 2 1. Medical Director, CRH Medical Corp; 2. Minnesota Gastroenterology, Chief of Gastroenterology, Abbott-Northwestern Hospital, Associate Professor of Medicine, University of Minnesota Abstract symptomatic hemorrhoids and anal fissures are very common problems. This article provides a review of the anatomy and physiology of the anorectum along with a discussion of the diagnosis and treatment of hemorrhoids and the commonly associated matters of anal sphincter spasm and fissures. The various office treatment modalities for hemorrhoids are discussed, as are the specifics of rubber band ligation (rBL), and a strategy for the office treatment of these problems by the gastroenterologist is given. The crh o’regan system™ is a technology available to the gastroenterologist that provides a safe, effective, and efficient option for the non-surgical treatment of hemorrhoids in the office setting. Keywords hemorrhoids, anal fissure, rubber band ligation, crh o’regan system™ Disclosure: Mitchel guttenplan is Medical Director of crh Medical Products corporation, the manufacturer of the crh o’regan system™. robert A ganz is a consultant to and holds equity in crh Medical Products corporation. Received: 2 november 2011 Accepted: 30 november 2011 Citation: Touchgastroentorology.com ; December, 2011. Correspondence: Mitchel guttenplan, MD, fAcs, 3000 old Alabama rd, suite 119 #183, Alpharetta, gA 30022-8555, us. e: [email protected] Diseases of the anorectum, including hemorrhoids and anal fissures, are experience also makes it clear that hemorrhoid sufferers frequently very common. The care of these entities is typically left to general and have additional anorectal issues that may both confuse the diagnosis colorectal surgeons. -
F • High Accuracy Sonographic Recognition of Gallstones
517 - • High Accuracy Sonographic f Recognition of Gallstones Paul C. Messier1 Recent advances in the imaging capabilities of gray scale sonography have increased Donald S. Hill1 the accuracy with which gallstones may be diagnosed. Since the sonographic diagnosis Frank M. Detorie2 of gallstones is often followed by surgery without further confirmatory studies, the Albert F. Rocco1 avoidance of false-positive diagnoses assumes major importance. In an attempt to improve diagnostic accuracy, 420 gallbladder sonograms were evaluated for gall- stones. Positive diagnoses were limited to cases in which the gallbladder was well visualized and contained densities that produced acoustic shadowing or moved rapidly with changes in position. Gallstones were diagnosed in 123 cases and surgery or autopsy in 70 of these patients confirmed stones in 69. There was one false-positive, an accuracy rate for positive diagnosis of 98.6%. Five cases were called indeterminate for stones; one of these had tiny 1 mm stones at surgery. The other four cases had no surgery. Of 276 cases called negative for stones, two were operated. One contained tiny 1 mm stones; the other had no stones. None of the 146 cases with negative sonograms and oral cholecystography or intravenous cholangiography had stones diagnosed by these methods. Because of its ease and simplicity, sonography is attractive as the initial study in patients suspected of having gallstones. With the criteria used here, a diagnosis of gallstones in the gallbladder can be offered with great confidence. Since 1974, the imaging capabilities of gray scale sonography have improved steadily, with corresponding increases in its accuracy in gallstone recognition. -
Cholecystokinin Cholescintigraphy: Methodology and Normal Values Using a Lactose-Free Fatty-Meal Food Supplement
Cholecystokinin Cholescintigraphy: Methodology and Normal Values Using a Lactose-Free Fatty-Meal Food Supplement Harvey A. Ziessman, MD; Douglas A. Jones, MD; Larry R. Muenz, PhD; and Anup K. Agarval, MS Department of Radiology, Georgetown University Hospital, Washington, DC Fatty meals have been used by investigators and clini- The purpose of this investigation was to evaluate the use of a cians over the years to evaluate gallbladder contraction in commercially available lactose-free fatty-meal food supple- conjunction with oral cholecystography, ultrasonography, ment, as an alternative to sincalide cholescintigraphy, to de- and cholescintigraphy. Proponents assert that fatty meals velop a standard methodology, and to determine normal gall- are physiologic and low in cost. Numerous different fatty bladder ejection fractions (GBEFs) for this supplement. meals have been used. Many are institution specific. Meth- Methods: Twenty healthy volunteers all had negative medical histories for hepatobiliary and gallbladder disease, had no per- odologies have differed, and few investigations have stud- sonal or family history of hepatobiliary disease, and were not ied a sufficient number of subjects to establish valid normal taking any medication known to affect gallbladder emptying. All GBEFs for the specific meal. Whole milk and half-and-half were prescreened with a complete blood cell count, compre- have the advantage of being simple to prepare and admin- hensive metabolic profile, gallbladder and liver ultrasonography, ister (4–7). Milk has been particularly well investigated. and conventional cholescintigraphy. Three of the 20 subjects Large numbers of healthy subjects have been studied, a were eliminated from the final analysis because of an abnormal- clear methodology described, and normal values determined ity in one of the above studies. -
Answer Key Chapter 1
Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6. -
Endoscopy Matrix
Endoscopy Matrix CPT Description of Endoscopy Diagnostic Therapeutic Code (Surgical) 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) X 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via X inferior meatus or canine fossa puncture) 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via X puncture of sphenoidal face or cannulation of ostium) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or X debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of hemorrhage X 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy X 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection X 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery X 31253 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) X 31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior 31256 Nasal/sinus endoscopy, surgical; with maxillary antrostomy X 31257 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical; with removal of -
Public Use Data File Documentation
Public Use Data File Documentation Part III - Medical Coding Manual and Short Index National Health Interview Survey, 1995 From the CENTERSFOR DISEASECONTROL AND PREVENTION/NationalCenter for Health Statistics U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics CDCCENTERS FOR DlSEASE CONTROL AND PREVENTlON Public Use Data File Documentation Part Ill - Medical Coding Manual and Short Index National Health Interview Survey, 1995 U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland October 1997 TABLE OF CONTENTS Page SECTION I. INTRODUCTION AND ORIENTATION GUIDES A. Brief Description of the Health Interview Survey ............. .............. 1 B. Importance of the Medical Coding ...................... .............. 1 C. Codes Used (described briefly) ......................... .............. 2 D. Appendix III ...................................... .............. 2 E, The Short Index .................................... .............. 2 F. Abbreviations and References ......................... .............. 3 G. Training Preliminary to Coding ......................... .............. 4 SECTION II. CLASSES OF CHRONIC AND ACUTE CONDITIONS A. General Rules ................................................... 6 B. When to Assign “1” (Chronic) ........................................ 6 C. Selected Conditions Coded ” 1” Regardless of Onset ......................... 7 D. When to Assign -
Chapter One General Introduction
Chapter One General Introduction 1.1Introduction: Magnetic resonance cholangiopancreatography (MRCP) is an abdominal magnetic resonance imaging method that allows non-invasive visualization of the pancreatobiliary tree and requires no administration of contrast agent. (Adamek HE et al, 1998). MRCP is increasingly being used as a non-invasive alternative to ERCP and a high percentage of the diagnostic results of MRCP are comparable with those from ERCP for various hepatobiliary pathologies. (Vogl TJ et al.2006). It has been exactly two decades since magnetic resonancecholangiopancreatography (MRCP) was first described. Over this time, the technique has evolved considerably, aided by improvements in spatial resolution and speed of acquisition. It has now an established role in the investigation of many biliary disorders, serving as a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP).It makes use of heavily T2-weighted pulse sequences, thus exploiting the inherent differences in the T2-weighted contrast between stationary fluid-filled structures in the abdomen (which have a long T2 relaxation time) and adjacent soft tissue (which has a much shorter T2 relaxation time). Static or slow moving fluids within the biliary tree and pancreatic duct appear of high signal intensity on MRCP, whilst surrounding tissue is of reduced signal intensity. (WallnerBK ,et al 1991). 1 Heavily T2-weighted images were originally achieved using a gradient-echo (GRE) balanced steady-state free precession technique. A fast spin-echo (FSE) pulse sequence with a long echo time (TE) was then introduced shortly after, with the advantages of a higher signal-to-noise ratio and contrast-to-noise ratio, and a lower sensitivity to motion and susceptibility artefacts. -
Provider Bulletin Prior Authorization Requirement for Gastrointestinal
Medicaid Managed Care Florida Healthy Kids Provider Bulletin August 2020 Prior authorization requirement for gastrointestinal codes done in the outpatient hospital setting (place of service 22) This communication applies to the Medicaid programs for Simply Healthcare Plans, Inc. and Clear Health Alliance as well as the Florida Healthy Kids program for Simply. Prior authorization requirements Effective October 1, 2020, prior authorization (PA) requirements will be required for the below CPT® codes if requested in the outpatient (OP) hospital setting. Prior authorization will be required for place of service 22 (OP hospital) only. No authorization will be required if done in an alternate OP place of service, such as an ancillary surgery center. For services that are scheduled on or after October 1, 2020, providers must contact Simply and CHA to obtain prior authorization for these services requested in the hospital. Providers are strongly encouraged to verify that a prior authorization has been obtained before scheduling and performing services in the outpatient hospital. To request PA, you may use one of the following methods: Web: https://www.availity.com* Fax: 1-866-495-1981 43200 ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC 44382 ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE 43202 ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY 44388 COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX 43215 ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY 45308 PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY 43220 ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM 45330 SIGMOIDOSCOPY -
Ultrasonography in Hepatobiliary Diseases
Ultrasonography in Hepatobiliary diseases Pages with reference to book, From 189 To 194 Kunio Okuda ( Department of Medicine, Chiba University School of Medicine, Chiba, Japan (280). ) Introduction of real-time linear scan ultrasonography to clinical practice has revolutionalized the diagnostic approach to hepatobiiary disorders. 1 This modality allows the operator to scan the liver and biliary tract with a real-time effect, and obtain three dimensional images. One can follow vessels and ducts from one end to the other. The portal and hepatic venous systems are readily seen and distinguished. Real-time ultrasonography (US) using an electronically activated linear array transducer is becoming a stethoscope for the liver specialist, because a portable size real-time ültrasonograph is already available. It is now established that real-time US is useful not only in the diagnosis of gallstones, dilatation of the biliary tract, and cystic lesions, but it can also assess liver parenchyma in various diffuse liver diseases. Thus, a wide range of diffuse liver diseases beside localized hepatic lesions can he evaluated by US. It can also make the diagnosis of portal hypertension 2-4 In our unit, the patient with a suspected hepatobiiary disorder is examined by US on the first day of hospital visit, and the next investigation that will pOssibly provide a definitive diagnosis, such as ERCP, PTC, X-ray CT, angiography, scintigraphy, etc., is scheduled. Using a specially designed transducer, a needle can be guided while the vessel, a duct, or a structure is being aimed and entered (US-guided puncture). 5 ;7 US-guided puncture technique has improved the procedure for percutaneous transhepatic cholangiogrpahy 8, biliary decompression, percutaneous transhepatic catheterizatiøn for portography 9, and obliteration of bleeding varices.