HMI203 - OSCE

Enema

• CI: Colitis, Diverticulitis, Volvulus, Intussusception, Neoplasm, Malaena (blood in stools)

• ContraI: Toxic Megacolon, Colonoscopy w/ Biopsy within 3 days, Appendicitis (Perf)

• Contrast: Barium —> Gastrografin

• Precare: Fast from midnight (diabetics first)

• Postcare: Hydration/Laxatives

Swallow

• CI: Dysphagia, Foreign Body, Neoplasm, Gastrointestinal Reflux (GERD)

• ContraI: Colitis, Diverticulitis, Volvulus, Intussusception, Appendicitis

• Contrast: Barium —> Gastro (depends)

• Precare: Fast from midnight (diabetics first)

• Postcare: Hydration/Laxatives

Meal

• CI: Obstruction, Masses, Diverticulitis, Gastric Carcinoma, Post Surgery

• ContraI: Large bowel obstruction

• Contrast: Barium —> Gastro

• Precare: Fast from midnight (diabetics first)

• Postcare: Hydration/Laxatives + Can’t drive (get smone else)

Follow Through

• CI: Crohn's disease, Diverticulitis, Polyps, Carcinoma, Pain

• ContraI: Large bowel obstruction??

• Contrast: Barium —> Gastro

• Precare: Fast from midnight (diabetics first)

• Postcare: Hydration/Laxatives + Can’t drive (get smone else)

Retrograde Pylogram

• CI: ureteric obstruction, trauma, stent placement, haematuria

• ContraI: UTI, Contrast Allergies, Bleeding Disorders

• Contrast: Iodine (Water-soluble)

• Precare: nil orally 6 - 8hrs prior + maybe laxative

• Postcare: Monitor urine output + if blood, Pain relief if required, Can’t drive

PCNL (Percutaneous nephrolithotomy)

• CI: Staghorn calculus, Post retrograde pyelogram

• ContraI: compromised respiratory/cardiovascular system

• Contrast: Iodine (Water-soluble)

• Precare: Fast 6/8hrs before, maybe laxatives

• Postcare: Cant Drive, May need monitoring, Puncture side pressure bandage

• WHAT IS IT: small incision behind kidneys to remove stones w/ Nephroscope

MCU (Micturating Cysto-urethrography)

• CI: Trauma, pain urinating, Haematuria, Reflux

• ContraI: Contrast allergies, Pregnancy*, UTI

• Contrast: Iodine

• Precare: Empty bladder prior

• Postcare: Monitor infection Symptoms

• WHAT: Visualise bladder + Urethra while urinating

Operative Cholagiogram

• CI: chronic cholecystitis

• ContraI: Comprimised respiratory/cardiovascular system

• Contrast: Iodine

• Precare: Fast 12hrs, no aspirin (blood thinner), physical exam to check overall health

• Postcare: Rest, Diet changes from doctor

• WHAT: Surgery to visualise Bile ducts

ERCP

• CI: Stone removal, bile duct leakage, increase bilirubin

• ContraI: unstable cardiovascular status, GIT perforation

• Contrast: Iodine (LOCM)

• Precare: Fast 12hrs

• Postcare: Rest, meds

• WHAT: Camera that goes to Duo to treat bile/pancreatic ducts

Joint Injection

• CI: Chronic pain, Arthritis, Gout, Carpal tunnel syndrome

• ContraI: Inaccessible joint, Signs of infection, Allergies, Broken skin at injection site

• Contrast: Iodine (LOCM)

• Precare: Explain whats happening

• Postcare: May have Severe Pain 2/3 days BUT after 3/5 days pain + inflammation should be reduced

• WHAT: inject meds (sterioids) to reduce pain + inflammation

What to do at the end

• ASK IF THEY HAVE ANY QUESTIONS