07/05/94  1100

ABDOMEN: A supine and decubitus view of the abdomen was obtained. The films are limited. There is some slight distention of the ileum which could be due to an adynamic ileus. The possibility of some abdominal ascites is raised. The study is not optimal, limiting interpretation.

Impression: Adynamic ileus, possible abdominal ascites on a limited examination. G. Newstead, MD/Nancy/SC

 07/07/94  0800

ABDOMEN: Supine and upright film of the abdomen demonstrates overall hazy density in the central and right abdomen with some displacement of the bowel loops. Possibility of either abdominal ascites or a large abdominal mass is suggested. There is degenerative change in the lumbar spine with compression of several lumbar vertebral bodies and heavy calcification of the abdominal aorta and its branches.

Impression: Supine and decubitus films of abdomen demonstrate the presence of either abdominal ascites or a large abdominal mass as discussed. G. Newstead, MD/Nancy/SC

 07/1094  0850 ABDOMEN: AP and supine shoot lateral show postoperative changes with dilated bowel probably due to minimal postoperative ileus. No free air can be seen. T.E. Hunt, MD/LM/DH
 07/12/94  1140

ABDOMEN:AP supine portable abdomen was done and compared with 7/10/94. There is no significant change with the tube in the stomach, and surgical clips and drain in the right upper quadrant.

Impression: No change from 7/10/94. T.E. Hunt, MD/JEN/RB

 07/18/94  0830

ABDOMEN: Supine, portable abdomen done. A nasogastric tube is noted with its tip in the distal portion of the stomach. There is still some small and large bowel minimal ileus, with no appreciable change in the interval.

Impression: No appreciable change in the small and large bowel ileus since the previous 7/10/94 exam. S.P. Burns, MD/JEN K/MB

 07/20/94  0300 ABDOMEN (PORTABLE): Shows the intestinal gas pattern to be normal. Surgical staples are present in the abdomen. The tip of the gastric feeding tube is in the fundus of the stomach. V. Erburg, MD/SHER/DH
 07/30/94  0740

ABDOMEN (PORTABLE): Portable abdomen film shows no change of the position of the feeding tube which is in the fundus of the stomach. There is now slightly more small bowel gas in the jejunal loops and some gas also in the terminal ileum and the ascending colon and the rectum.

Impression: Some post operative ileus. No change of the position of the feeding tube. V. Erburg, MD/KEN/DH






GASTROGRAFIN GI SERIES: The position of the nasogastric tube was changed by St. Jean, MD and nasogastric tube was inserted with the tip located in the distal stomach. A Gastrografin GI Series was performed with contrast injected through the nasogastric tube. Filling of the stomach and duodenal bulb with some filling of the proximal jejunum was noted, but there was very delayed transit time and films taken up until 1 hour following injection do not demonstrate any significant passage of Gastrografin through the small intestine. The previously noted other abdominal findings are again seen. There was no evidence for perforation. Significant gastro-esophageal reflux was demonstrated.

Impression: GI Series, limited examination with Gastrografin does not demonstrate any gastric perforation. G. Newstead, MD/KM/RB





ABDOMEN AND RETROPERITONEUM:Ultrasound examination of the right upper quadrant was performed. A gallbladder study was requested; we were unable to outline the gallbladder. There are multiple fluid-containing structures noted in the intrahepatic region, whether they represent merely massively dilated fluid-filled loops of bowel of a mass lesion such as an infrahepatic abscess or other cystic mass lesion cannot be evaluated by this examination. Computerized tomography would be helpful in further elucidation of this lesion.

Impression: Multiple fluid-containing structures in the infrahepatic region are noted as discussed. G. Newstead, MD/RB



ABDOMEN AND RETROPERITONEUM:A gallbladder and pancreatic ultrasound examination was performed. The gallbladder and pancreas were outlined moderately well and appear normal. No abnormality is noted.

Impression: Normal study. G. Newstead, MD/LL/SC





UPPER G.I. TRACT: Pre-endoscopy diagnosis - acute upper G.I. bleed. Procedure EGD. Post-endoscopy diagnosis - see below.

Sedation was accomplished with 2.5mg Valium IV, local anesthesia could not be delivered because patient was uncooperative. The endotracheal tube was deflated and after positioning bite block between her gums the endoscope was inserted into the esophagus. The proximal esophagus appeared grossly normal and showed superficial bleeding coming from the esophagus. Cardioesophageal sphincter was located at 38cm from the incisor teeth. They appeared grossly normal. Blood coming from above. The stomach was entered and insufflated. The fundus showed superficial ulcerations and hemorrhagic gastritis on the greater curvature and on the posterior wall of the fundus. A 1cm superficial ulcer was seen and showing signs of recent bleed. Body and antrum of the stomach appeared normal with no evidence whatsoever of any inflammation or bleeding. The pylorus showed good tone. The bulb was entered and insufflated and showed normal mucosa, as did the second portion of the duodenum. The scope was then retracted back into the stomach. The esophagus was seen in retrograde manner.

Impression: (1) Bleeding from superficial lesion of the mid-esophagus. (2) Bleeding from the fundus from superficial ulcerations and hemorrhagic gastritis. (3) Normal body, antrum of the stomach. (4) Normal pylorus, bulb and second portion of the duodenum. A.F.O. Hadamard, MD/DH





ABDOMEN: Multiple views of the abdomen, consisting of a supine and upright film, were obtained. The intestinal pattern appears normal. No free air is seen within the peritoneal cavity. The visualized abdominal organs do not appear to be remarkable and no signifigant soft tissue calcifications are seen.

IMPRESSION: Normal abdomen

INTRAVENOUS PYELOGRAM: Preliminary film of the abdomen is normal. Following the injection of intravenous contrast, both kidneys apppear to be normal in size, shape, and position. No abnormal calcifications are noted. There is adequate excretion bilaterally. The calyceal system, pelves, and ureters are within normal limits. The bladder is not remarkable.

IMPRESSION: Normal intravenous pyelogram.