rectum, five polyps were seen. The largest measured about 1 cm (centimeter) in diameter. Three were pedunculated. These were snared. Two others were smaller and sessile. The distal rectum was normal. The scope was withdrawn. The patient tolerated the procedure well and was discharged ambulatory with a driver. RECOMMENDATIONS: Follow-up colonoscopy in 2 years due to the relatively large number of polyps seen on this examination in a relatively young man. Pathology Report Later Indicated: See Report 7-8B. SERVICE CODE(S): _______________________________________ ICD-10-CM DX CODE(S): ___________________________________ CASE 7-14 Operative Report, Cholecystectomy The patient in this case presents with biliary dyskinesia (gallbladder dysfunction). The gallbladder of a patient with biliary dyskinesia appears normal on ultrasound scan, but when the gallbladder is stimulated to contract with food or with the stimulating hormone
HIT 213 Week 4 Coding Cases Homework Chapters 7 and 8 CCK, the gallbladder does not contract properly. Another diagnostic tool often used is the HIDA scan, which is a special type of isotope scan used to visualize the gallbladder emptying (ejection fraction). The patient in the following case has an abnormal CCK and HIDA scan and is having the gallbladder removed. LOCATION: Outpatient, Hospital PATIENT: Karen Daniels PHYSICIAN: Larry Friendly, MD PREOPERATIVE DIAGNOSIS: Biliary dyskinesia POSTOPERATIVE DIAGNOSIS: Biliary dyskinesia PROCEDURE PERFORMED: Laparoscopic cholecystectomy ANESTHESIA: General INDICATION: The patient is a 39-year-old female who presents with an abnormal CCK HIDA (hydroxy iminodiacetic acid [imaging test]) scan. She presents today for elective laparoscopic cholecystectomy. She understands the risks of bleeding, infection, possible damage to the biliary system, and possible conversion to open procedure, and she wishes to proceed. PROCEDURE: The patient was brought to the operating table and placed under general anesthesia. Foley catheter and orogastric tubes were inserted, and she was prepped and draped sterilely. A supraumbilical skin incision was made with a no. 11 blade, and dissection was carried down through subcutaneous tissues. Bluntly, midline fascia was grasped with a Kocher clamp, and 0 Vicryl sutures were placed on either side of the midline fascia. The Veress needle was then inserted into the abdominal cavity; drop test confirmed placement within the peritoneal space. The abdomen was insufflated with carbon dioxide, and a 10-mm (millimeter) trocar port and laparoscope were introduced, showing no damage to the underlying viscera. Under direct vision, three additional trocar ports were placed, one upper midline 10 mm, two right upper quadrant 5 mm. The gallbladder was grasped and elevated from its fossa. The cystic duct and artery were dissected and doubly clipped proximally and distally, dividing them with the scissors. The gallbladder was then shelled from its fossa using electrocautery and brought up and out of the upper midline incision. The abdomen was irrigated with saline until returns were clear. There was no bleeding from the liver bed. Clips were in with no evidence of bleeding. When we were removing the final port, we could see down in the
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- Fall '17