CONTACTS
0201 - Veterans Administration
020101 - Ms. Kathleen Clancy
020102 - Nurse Practioner; Primary Care Provider
020103 - Primary Care Center
0202 - Veterans Administration
020201 - Mr. John NLN; Technician
020203 - Imagery Xray Department
020204 - Dr. NFN Kim, MD
020206 - Imagery Xray Department
SUBJECTS
Meeting VA Martinez CA Imaging Barium Sulfate Evalute Digestion Disc
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background performing work today ordered on 050629 when Doctor Sandhu
040902 - scheduled a chest Xray to evaluate hiatical hernia. ref SDS 12 I597
040904 - ..
040905 - Check in at 1000. This is scheduled today because of equipment
040906 - problems reported on 050706. ref SDS 13 0K8K
040908 - ..
040909 - Follow procedures not to eat or drink anything after midnight before
040910 - the xray, reported on 050629. ref SDS 12 SO99
040912 - ..
040913 - Perform xray scheduled on 050629 by Doctor Sanduh to evaluate hiatical
040914 - hernia. ref SDS 12 I597
040915 -
040917 - ..
0410 -
0411 -
0412 - 1628
0413 -
041301 - Called VA asked for Kathy Clancy.
041302 -
041303 - Operator said VA changed the assignment and made Doctor Sanduh the
041304 - primary care practitioner.
041306 - ..
041307 - Doctor Sanduh says in the Clinic Instructions on 050629 1000 to call
041308 - VA for a meeting after the Radiology test is performed. ref SDS 12
041309 - 1X4O
041310 -
041311 - [On 050816 meeting with doctor. ref SDS 14 0001
041312 -
041313 -
041314 -
041315 -
041316 -
041317 -
0414 -
SUBJECTS
Swallow Test Barium Radiology Imaging Evalute Digestion Swallow Prob
Hiatic Hernia Big Gastric Examination Digestion Imaging Barium Sulfa
Duodenal Obstruction Pylorus Constricted Gastric Examination Digesti
Imaging Barium Sulfate Evalute Digestion Discovered Possible Duodena
Hiatal Hernia Big Gastric Examination Digestion Imaging Barium Sulfa
2107 -
2108 - 1025
210901 - ..
210902 - CT Swallowing Test Radiology Barium Diagnose Problem and Xrays Chest
210903 - Xrays Chest and CT Barium Swallow Test Diagnose Swallowing Problem
210904 - Barium Swallowing CT Test Diagnose Problem and Xrays Chest
210905 -
210906 - John took xrays of the upper chest. One from the back and another
210907 - from the front.
210908 -
210910 - ..
2110 -
2111 -
2112 - 1042
2113 -
211301 - Doctor Kim did the CT barrium swallow imagery, because Doctor O'Conner
211302 - had a family emergency today.
211304 - ..
211305 - The patient first swallows a small amount of alkaselser and then some
211306 - water to expand the stomach.
211308 - ..
211309 - All of the imagery was accomplished from a standing position. John
211310 - switched the table from prone to vertical. I could then stand on a
211311 - ledge.
211313 - ..
211314 - Patient swallows from 33% to 50% of the contents in a plastic bottle
211315 - of barium sulfate, about half a quart. This is a heavy mushy
211316 - substance that has a tolerable taste.
211318 - ..
211319 - The computer technology (CT) captures and displays realtime video
211320 - scans on a monitor that shows realtime barium liquid swallowed from
211321 - the mouth through the esophagus and into the stomach.
211323 - ..
211324 - The doctor initially commented to John that something is contsricting
211325 - the liquid barium from falling into the stomach.
211327 - ..
211328 - He described a big "hiatal hernia."
211330 - ..
211331 - Patient then swallows a more liquified form of barium sulfate to test
211332 - processing liquids.
211334 - ..
211335 - There was no mention of cancer or other cyst-like growth in the
211336 - esophagus nor the stomach.
211338 - ..
211339 - The doctor mentioned the constriction has the appearance of a "bird
211340 - beek."
211342 - ..
211343 - The doctor moved the monitor forward for the patient to see the
211344 - imaging. He pointed to large bulge and explained this is the
211345 - esophagus above the stomach. He traced a long string-like image from
211346 - the upper bulge to a lower bulge, which he said is the stomach. The
211347 - doctor indicated that the long string-like structure severely
211348 - constricts swallowing, causing swallowed content to backup and expand
211349 - the esophagus into the large buble above the stomach shown on the
211350 - monitor.
211351 -
211352 - | |
211353 - | |
211354 - | |
211355 - | | Esophagus
211356 - | |
211357 - / \
211358 - / \
211359 - / \ Bulge
211360 - | \
211361 - \ \
211362 - \ |
211363 - \ -
211364 - --\ /
211365 - \ /
211366 - \
211367 - \
211368 - |
211369 - | string-like structure
211370 - |
211371 - |
211372 - |
211373 - --
211374 - / \
211375 - / -----\
211376 - | -\
211377 - | - Stomach
211378 - | |
211379 - | |
211380 - / /
211381 - / --------- /
211382 - | /
211383 - \ \
211384 - \ -----------
211385 - ------------------
211387 - ..
211388 - [On 050830 1000 VA radiology report aligns with
211389 - understandings from the test today, ref SDS 15 6G7I, and
211390 - diagnoses condition of achalasia, with recommendation for
211391 - endoscopy to test for cancer. ref SDS 15 6H9S
211393 - ..
211394 - [On 050816 doctor mentions Achalasia as initial diagnosis,
211395 - and research found an explanation that mentions "bird beak"
211396 - like constriction of digestion system. ref SDS 14 DG97
211398 - ..
211399 - [On 051202 1430 Doctor Lee showed radiology image file from
211400 - the barium swallow test on 050714, and described an extreme
211401 - exaggerated bulge constricted by an excessively elongated
211402 - lower esophageal sphincter valve and diagnosed this
211403 - disorder as achalasia. ref SDS 17 5B5K
211405 - ..
211406 - [On 100928 0706 report of another barium swallow test
211407 - performed on 091216, 2 days after Heller Myotomy surgery at
211408 - VA in San Francisco on 091216, again reported "bird beak"
211409 - appearance, dilated and persistent narrowing of esophagus
211410 - common to achalasia. ref SDS 18 HB5M
211412 - ..
211413 - [On 130117 0900 barium swallow CT test shows significant
211414 - improvement compared to original condition on 050714,
211415 - ref SDS 0 B94J - there is no big bulge and no long
211416 - string-like structure preventing content from flowing into
211417 - the stomach. ref SDS 19 OH6G
211419 - ..
211420 - [On 150527 0930 VA Medical Center in San Francisco
211421 - performed another CT Barium Swallow test - preliminary
211422 - results are favorable indicating patient has not suffered
211423 - recurrent achalasia symtom of distorted esophagus, commonly
211424 - called "bird beak," rather esophagus looks normal.
211425 - ref SDS 20 V56N
211427 - ..
211428 - After the doctor completed work on imagery tests, John, the
211429 - technician, took two (2) more standard xrays of the stomach and lower
211430 - abdomen.
211432 - ..
211433 - Requested a copy of the imaging file.
211435 - ..
211436 - John said he cannot submit a copy of the patient's medical records
211437 - created today.
211439 - ..
211440 - Instead, John drew a diagram reflecting images observed during the
211441 - barium swallow test that indicate there is an extreme bulge in the
211442 - esophagus above the string-like structure leading to the stomach, and
211443 - this esophageal bulge is nearly the size of the stomach, shown above.
211444 - ref SDS 0 B94J
211446 - ..
211447 - John explained hiatal hernia can expand the stomach into various buble
211448 - forms below the lower esophagael sphincter valve and this expansion
211449 - can affect the lungs. John indicated he did not observe this
211450 - condition in imaging study today. He seemed to say the stomach looks
211451 - normal.
211452 -
211453 - [On 051202 examination and review of imaging taken today
211454 - indicates the problem is at the gastroesophageal junction
211455 - causing primary achalasia. ref SDS 16 5B5K
211457 - ..
211458 - Imagery today seems to indicate the pylorus is constricted with a
211459 - constant spasm that prevents food flowing from the stomach into the
211460 - duodenum that leads to the small intestine. The pylorus typically
211461 - spasms by opening and closing at a junction with the duodenum, which
211462 - empties the stomach for digestion by the intestine system. In this
211463 - case, natural spasm of opening and closing is not occurring, but
211464 - rather the opening is fixed in a near closed position, which is the
211465 - doctor's reference to a "bird's beek." This constricted opening at the
211466 - pylorus allows small amounts of food in the stomach to gradually seep
211467 - into the intestine for digestion. Therefore, normal eating cycles
211468 - result in food build up in the stomach. Food in the stomach continues
211469 - to breakdown. New food enters in a more solid state, and so sinks to
211470 - the bottom forcing the more liquified, undigested food from prior
211471 - eating cycles to to rise, resulting in vomiting.
211472 -
211473 - [On 050816 doctor mentions Achalasia as initial diagnosis, and
211474 - research found an explanation that mentions "bird beak" like
211475 - constriction of digestion system. ref SDS 14 DG97
211477 - ..
211478 - [On 050830 received doctor's analysis of image testing, ref SDS 15 UR3M,
211479 - which
211480 - identifies achalasia symptoms. ref SDS 15 6H9S
211482 - ..
211483 - [On 051202 examination and review of imaging taken today indicates
211484 - the problem is at the gastroesophageal junction causing primary
211485 - achalasia. ref SDS 16 5B5K
211486 -
211487 -
211489 - ..
2115 -
2116 -
2117 - 1329
2118 -
211801 - Search for...
211802 - duodenum pylorus
211803 -
211804 - ...found a number of articles, including the following...
211805 -
211806 - Health AtoZ
211807 - Encyclopedia Index D
211808 - Citing
211809 - Gale Encyclopedia of Medicine, December 2002
211810 - J. Ricker Polsdorfer MD.
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