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Biliary and Pancreatic Sphincterotomies for Sphincter of Oddi Dysfunction
This 43 year old woman has severe recurrent RUQ pain post cholecystectomy. Liver and pancreatic chemistries and duct size are normal, but pancreatic manometry is abnormal. The plan is to perform dual biliary and pancreatic sphincterotomy. The pancreatic duct is cannulated with a 3.9 French tip tr...iple lumen papillotome loaded with a 0.025 inch Jagwire. Contrast is injected to outline the course of the duct. The wire is passed to the tail. Notice the knuckling of the wire into the tail. This provides a safety loop, but is only safe in a small duct with use of a smaller caliber wire. Then with the wire securely in PD, papillotome is used to cannulate the bile duct. Placement of the wire in PD guarantees access for pancreatic stent placement, which is mandatory in these patients to reduce risk, it also facilitates difficult biliary cannulation. Here is the fluoroscopic view as the papillotome is passed deep into bile duct. This shows wires in the CBD and PD. Now a biliary sphincterotomy is performed, with the pancreatic guidewire in place beside the papillotome. The scope is pushed into a longer position to orient up the middle of the papilla. The sphincterotomy is done in very careful stepwise fashion to avoid perforation. Now the biliary wire is removed and the papillotome passed over the pancreatic wire for pancreatic sphincterotomy. The incision is aimed back up towards the biliary sphincterotomy to ensure the septum only is cut. Note the large pancreatic orifice. Last, a 4 French 9cm unflanged soft material pancreatic stent is placed. We always use single pigtail design to avoid inward migration of the stent. The long unflanged design allows spontaneous passage within a few weeks.
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The purpose of this video is to help you learn what to expect while you are in hospital, and how to care for yourself after surgery so that you can have the best recovery possible.
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This patient presented to the ER for umbilical pain and had a history of umbilical hernia. He was concerned about the possibility of incarceration of the hernia.
In this video we explain how the clinical exam helps to differentiate a simple painful hernia from an incarcerated one.
***Thanks to the patient for sharing his history and exam with YouTube world***
Ophthalmoscopy - Eye Clinical Examination - OSCE - Dr Gill
Direct Ophthalmoscopy use of the eyes is a very challenging clinical skill, incorporating both the examiner's knowledge of the retina, but also understanding the use of the ophthalmoscope
In this clinical skills tutorial, we look at the use of the direct ophthalmoscope as part of an ophthalmic examination
it should be noted that in the ideal circumstances, the room lights will be dimmed during the examination, and dilating eye drops used to improve the visualisation of the fundus
Some people may notice an ASMR effect from this clinical examination
#DrGill #Ophthalmoscopy #ClinicalSkills #EyeExam
This minimally invasive procedure connects electrodes to the brain and places a pacemaker-like device under the skin. When activated, electrical impulses minimize shaking due to "dyskinesia syndrome" in patients with Parkinson's disease. ~ Detroit Medical Center