Coronary Angioplasty Cardiac Catheterization Stent Placement

Coronary Angioplasty Cardiac Catheterization Stent Placement & CABG On-Pump PreOp Patient Education - http://PreOp.com

Coronary Angioplasty with Stent Placement -Patient Education

To do a cardiac cath, a cardiologist places a thin tube called a catheter through an artery in your leg or arm to reach your heart.
The Femoral artery in the leg is most commonly used. The catheter is inserted into the artery in the groin then guided to reach the heart.
The radial artery in the arm is another site that a catheter can be placed. The catheter is inserted at the wrist then guided to reach the heart.
Which artery is selected for the procedure depends on your personal situation, and the experience and training of your Cardiologist.
A contrast dye that can be seen with an x-ray machine is given.
X-ray pictures and video of the dye show the cardiologist how blood is moving through your heart.

Treatment of coronary artery disease is based on several factors, including your other existing medical problems, particularly diabetes,...as well as how many arteries are blocked, ….and how severe, and where the arteries are blocked.

Non-invasive recommendations can include,
lifestyle changes, like improving your diet, starting an exercise routine, and finding ways to manage your stress. Also, quitting smoking and making changes in medications.

Common procedures to treat coronary artery disease include,
open heart bypass surgery to replace blocked arteries, and….
angioplasty to improve blood flow through the blockages

A heart catheterization procedure, also called cardiac cath is needed to decide which treatment option is appropriate for you.

A cardiac cath is the first step of an angioplasty

CABG On-Pump PreOp Patient Education

Your doctor has recommended an “on pump” coronary artery bypass graft procedure, also called CABG
Before we talk about this procedure, let’s review some information about your body and your medical condition.

The heart is in the middle of the chest, under the ribs.
It is protected by the sternum, also called the breastbone.
The heart is a muscle that pumps blood to all parts of the body through blood vessels called arteries.
Veins are vessels that carry blood back to the heart.
The aorta is the largest artery in the body.
Two vessels that branch off from the aorta, are the right and left coronary arteries. They supply the heart muscle with the oxygen rich blood that is necessary to keep it working.
Coronary arteries can become blocked by plaque, fat and calcium deposits that build up over years.

The result is coronary artery disease, also called heart disease.

Severe blockages cause chest pain, heart attacks, and sometimes death.

During a CABG procedure, new pathways called bypasses are put in place to carry blood past, and around blockages.

Healthier blood vessels from other sites in the body are used to create each bypass.

A section of vein from your leg, or an artery from your arm, may be removed and used to create the bypass. These transplanted vessels are called grafts.

The right and left internal thoracic arteries are also commonly used as grafts.
These arteries naturally pass close to the heart. When creating a bypass with one of these vessels often only one end of the vessel is moved to the coronary artery, past the blockage.
This concept is similar to moving a hose from watering one plant to another.

When arteries or veins are moved or removed from one body part to another, this possible only when there will still be enough blood supplied from other nearby vessels.

There are different surgical techniques for coronary artery bypass, on pump and off pump.

During the several hours it takes to do an on pump CABG surgery, the heart is stopped for about 30 - 90 minutes. This keeps the heart muscle still while the surgeon sews vessels into place to create the necessary bypasses.

While the heart is stopped, a special pump, called a heart-lung machine, keeps blood oxygenated and flowing through the body.

Blood is carried from the body through tubing to a machine where it is mixed with oxygen, then pumped back to the body.

After all of the grafts have been placed, the heart is restarted, and the pump is disconnected.

In some situations a less invasive CABG procedure may be offered. This can include an off pump technique where the heart is not stopped. In some cases smaller incisions may be used.

During these procedures, converting to an on pump procedure is still possible.

Individual surgical treatment decisions depend on many factors, including the experience of the surgeon, how many arteries are involved, the location of the blockages, and their severity.

Assist with TUB bath - PreOp® Patient Education

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The supplies you will need to have easily accessible in the bathroom include:

    * Clean clothing

    * skid-proof plastic bath mat

    * 2 washcloths

    * 2 towels

    * soap

    * shampoo

    * plastic pitcher

    * skin lotion

    * comb and brush

    * disposable gloves

    * and a sealable plastic storage bag

Ensure that the bathroom is pleasantly warm, around 70. Place the skid-proof plastic bath mat in the tub and fill one-third of the tub with warm water. Test the temperature of the water with your hand.

Wash and carefully dry your hands.

Put on your disposable gloves.

Help your patient undress and place soiled clothing in the plastic bag in the laundry hamper.

Help your patient sit on the edge of the tub. If there is a grab bar on the back wall of the tub, have the patient hold it with one hand.

Swivel and lift both legs into the tub.

From the back, support your patient under both arms and help him slowly lower his body into the water.

Encourage your patient's independence and have him do as much of the washing as possible.

You may need to assist in such areas as the patient's back and to rinse off all soap with the shower extension or a pitcher.

If it's shampoo time and the patient cannot do it himself,

you can have him hold a dry, folded washcloth over his eyes to protect them.

Pour clean, warm water over the patient's head using a pitcher or a shower extension.

Rub in shampoo and massage the patient's head.

Rinse off the shampoo with clean warm water using a pitcher or a shower extension.

Dry the hair

If possible have the patient stand and help him dry his upper body. Otherwise, dry his upper body and arms with him sitting in the tub.

Let the water out of the tub.

With the towel over his upper body, help the patient sit on the edge of the tub.

Support the patient and help him swivel his legs over the edge of the tub. He can rest for a while, if need be.

Help dry the rest of the body, paying attention to under the arms and other skin creases and between the toes..

Apply body lotion to the skin and help the patient dress.

After making your patient comfortable, return to the bathroom, place soiled towels and washcloths in the laundry bag, clean the tub and mop the floor.

Remove your gloves, discard them into a plastic storage bag. Seal the bag and place it in the trash.

Carefully wash and dry your hands.

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Cataract Surgery - Small Incision PreOp® Patient Education Engagement

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Your doctor has recommended that you undergo lens replacement surgery to treat a cataract. But what does that actually mean?



The human eye is constructed like a camera - with a clear lens in the front. The lens is located just behind the iris. It is contained in an elastic capsule. This capsule will serve as the housing for the new lens. All light that enters the eye has to pass through this lens.



As we age, this lens can become cloudy and gradually lose its ability to focus properly. This is called a cataract.If left untreated, a cataract can grow steadily worse - interfering more and more with your vision.

Generally, replacing a cataract with an artificial lens is a simple procedure.



It usually involves a single incision in the white of the eye. Through this single opening the cataract is removed and the artificial lens is inserted.



Your Procedure:



On the day of your operation, you will be asked to put on a surgical gown.



You may receive a sedative by mouth and an intravenous line may be put in.



And you'll given eye drops to dilate, or open, the pupil.



You will then be transferred to the operating table.



To begin, the surgeon will use a special instrument to gently hold the eyelids apart.



Then the surgeon will apply an antiseptic solution to the skin around the eye before injecting a local anesthetic.





While the anesthetic is taking effect, the surgeon will position a microscope in front of the eye.



By now, the pupil will be fully open, or dilated.



When the operative field is numb, the surgeon will use the microscope to help make a very small incision just 3 millimeters above the iris. The lens is located just behind the iris contained in the elastic capsule.



Next the surgeon will open the top of the capsule and remove the lens. Most likely, your doctor will use a small probe which vibrates at a high frequency.



The probes vibrations break the old lens into microscopic pieces which can then be drawn out with gentle suction.





Through the small incision, the surgeon will then insert the new lens.



The lens is actually rolled up inside a special injector, designed to fit through the small incision made above the iris.



With the tip of the injector inside the eye, the surgeon slowly injects the new lens where it unfolds into position.



Because of the small size of the incision, often your surgeon will complete surgery without putting in any stitches.



Vision will gradually improve during normal healing over a period of 5 to 8 weeks.



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Permanent Pacemaker Implant Surgery • PreOp® Patient Education ❤

Permanent Pacemaker Implant Surgery - PreOp®  Patient Education

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Your doctor has recommended that you receive a permanent pacemaker implanted in your body. But what does that actually mean?



The heart is located in the center of the chest, enclosed by the breast bone and rib cage. By contracting in a rhythmic way, it causes the blood in your body to circulate.



A normally functioning heart beats at a rate of between 60 and 100 contractions per minute.



These contractions are triggered by a small piece of heart tissue called the SA node. The SA node generates a small electrical signal that is transmitted by nerves to the surrounding muscle. These electrical impulses are what cause the heart muscle to contract.



In some people, the SA node fails to cause the heart to contract with its normal rhythm, causing an abnormal heartbeat or arrhythmia. The most common form of arrhythmia, for which pacemaker surgery is often recommended, is bradyarrythymia - or slow heart rate.



There are a number of reasons why you may have developed an arrhythmia, but in most cases the problem is caused by a disruption in the SA node or in the system of nerves that conducts electrical signals to the heart muscle.



A pacemaker is a device that is designed to provide an electrical signal to the heart muscle and to help it maintain a proper rhythm. There are several types of pacemakers and the particular model selected for you will be based on your specific condition. But all pacemakers share a common design.



Your pacemaker will consist of two major pieces . . . a small metal box that contains a battery and other electronic components and an insulated wire, called a lead, which will carry the electrical impulses from the pacemaker to the heart.



Your pacemaker will be permanently implanted in your chest and, depending on your condition, either one or two leads will be attached to the heart muscle.



Your Procedure:



On the day of your operation, you will be asked to put on a surgical gown.



You may receive a sedative by mouth and an intravenous line may be put in.



You will then be transferred to the operating table.



To begin, skin is swabbed with an antiseptic solution and a sterile drape will be placed around the operative site.



Then the surgeon will make a small skin incision in the upper chest, just below the collarbone.



A pocket is then created between the skin and the tissue that covers the chest muscle.



Next, the team will use instruments called retractors to hold back the skin and underlying tissue. They'll locate a large blood vessel called the subclavian vein.



Using a special needle and syringe, your doctor will puncture the wall of the vein.



A thin guide wire is then inserted through the needle and into the vein. Your doctor gently pushes the wire until it reaches the heart.



Using an instrument called a fluoroscope the surgical team is able to see the wire's progress through the vein and into the beating heart.



Once the wire is in place, the needle is removed and a catheter - or hollow tube - is passed over the guide wire and into the heart.



One or two leads are then passed through the catheter.



When the lead or leads are in their proper position, the catheter is removed.



Finally, the lead is connected to the pacemaker, the pacemaker is inserted into the pocket below the collar bone and the incision is closed.



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Now let’s learn about what may occur after surgery, some risks of surgery, and what you can do to help.

It is important for you to “speak up” and tell your care team if you have more than expected pain or problems.

They will be watching for early, rare complications.



For the best recovery, follow your instructions after surgery that may include information about,



Call your doctor if you have trouble with diarrhea, vomiting or worsening constipation.  Call if you cannot urinate, have a fever, or pain that is getting worse even with rest and medication.

Call 911 if you have chest pain, shortness of breath, dizziness, bleeding that doesn’t stop, and any other sign that you may be having a complication from the procedure.



Hospital admission, medication or (additional) surgery may be needed to correct some problems.





To avoid cancellation or complications from anesthesia or your procedure, your job as the patient is to   

not eat, drink or chew gum after midnight, the night before the procedure unless you are given different instructions

take only medications you were told to on the morning of the procedure with a sip of water

follow instructions regarding aspirin and blood thinners before surgery,

and arrive on time



 This video is intended as a tool to help you to better understand the procedure that you are scheduled to have or are considering.  It is not intended to replace any discussion, decision making or advice of your physician.



#cardiac  #coronary #heartmonth #HeartHealth

PreOp® Coronary Artery Bypass Graft (CABG ) Off-Pump Patient Education

Coronary Artery Bypass Graft (CABG ) Off-Pump PreOp® Patient Education

https://www.preop.com/preop/coronary-artery-bypass-graft-cabg-off-pump



What is heart bypass surgery?



When the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle.

These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.



Your heart is located in the center of your chest.

It is surrounded by your rib cage and protected by your breastbone.



Your heart’s job is to keep blood continually circulating throughout your body.



The vessels that supply the body with oxygen-rich blood are called arteries.



The vessels that return blood to the heart are called veins.



Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood. The arteries that carry this blood supply to the heart muscle are called coronary arteries.



Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque.



Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger.



Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein.



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Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle.



These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.



One or more sections of blood vessel will be taken from the leg, thigh or chest wall and the incision at those points will be sutured and bandaged.



Then, your doctor will make a vertical incision in the center of the chest.



Skin and other tissue will be pulled back in order to expose the breast bone.



Your doctor will carefully divide the breast bone and a special instrument called a retractor will be used to hold the chest open.



Once your doctor has a clear view of the heart, he or she will make an incision in the pericardium – a thin membrane that encloses the heart.



Pulling the pericardium back will reveal the beating heart.



Next, the surgeon will gently rotate the heart to the right in order to allow access to the heart's underside.



Using veins taken from another part of your body, the team will begin to build new paths for blood  bypassing the blocked areas of the old artery or arteries. The team will attach as many new veins as needed to the underside of the heart.



Then, the doctor will gently rotate the heart back to its normal position.



To complete the bypass graft procedure, your doctor attaches the ends of the new veins on either side of the diseased area or areas of the old coronary artery. Blood can now flow freely avoiding the clogged areas that had caused your symptoms.



The pericardium can now be closed over the heart.



Your doctor will position two special drainage tubes in the chest cavity.



These tubes prevent fluid from building up around the heart during the healing process.



The breast bone is then closed with metal wire and the remaining tissue is closed with sutures.



Finally a sterile bandage is applied.



Patient Education and Patient Engagement



#HeartMonth #AmericanHeartMonth #patienteducation

PostCare™ Handwashing patient Education

Handwashing • PostCare™ Patient Education & Patient Engagement

https://info.preop.com/PostCare_Handwashing



This video is about washing your hands to get rid of germs so that you don’t spread infection.

Germs are bacteria, yeast, and viruses that cause sickness and infection. They are so small you can’t see them. 



Germs are always on your hands and can be spread to other parts of your own body, to the person you are caring for and to anything else you touch.



Wash your hands after you cough, sneeze or blow your nose, handle trash and after you touch anything bloody or dirty.



You must wash your hands before and after you take care of a patient, touch their food or drink, and use the toilet.



For good handwashing, you need to wash for 20-30 seconds almost half a minute.  You can time yourself by humming the “Happy Birthday” song two times.  If you can see dirt on your hands, it takes even longer to get them clean, don’t rush.





Rubbing your hands together loosens dirt and germs from your skin and the running water washes them away.



Pay attention to clean the tops and bottoms of your hands, between your fingers, and under your nails.



Use liquid soap if possible because bar soap can have germs on the outside.



Make sure paper towels and a trash bin are nearby.



Remove jewelry from your hands except for a wedding band and push your sleeves up.



Turn on the water and wet your hands.



Pump enough soap from the dispenser to cover your hands as you rub them together.



 Start counting to 20 slowly at this point, or hum the “happy birthday” song 2 times.



Rub your fingers together, the back of each hand and around each thumb.



Get soap under your fingernails by rubbing your nails against the palm or inside of your other hand. If your nails are dirty, clean under them.



Keep rubbing your hands together until the end of your count.



Rinse your hands completely.



Because the sink has germs, use a paper towel to turn off the water.



Throw away the paper towel.



Use a new paper towel to dry your hands completely.



Then throw it away.



If soap and water are not available you may use alcohol-based, waterless hand sanitizers.  Use enough sanitizer to cover your hands completely when you rub them together and keep rubbing them together until they are dry.



Waterless sanitizers kill most but not all germs.  Sanitizers are not as good as soap and water for germs from diarrhea, especially a bacteria called CDiff (say “C” “Diff”).

They also do not work if you can see dirt on your hands or if they are wet from blood or something else.



Key points to remember with handwashing are to use soap from a pump dispenser, rub your hands together for 20-30 seconds, and rinse completely with water.



Remember with waterless hand sanitizers to rub in until dry, that they are not a good choice if you see dirt on your hands and that they do not kill all germs, especially those from diarrhea.



This video is intended as a tool to help you to better understand the care instructions that you have been given.  It is not intended to replace any specific advice or personal care instructions that you have received from your care team.  If you have any questions or problems please be sure to call or be seen.

PreOp® Hysterectomy Removal of the Uterus

Hysterectomy Removal of the Uterus Surgery - PreOp® Patient Education



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Your doctor has recommended that you have a hysterectomy. But what does that actually mean?



Hysterectomy is the removal of the uterus - the organ that holds and protects the fetus during pregnancy.



Hysterectomy often also involves the removal of other parts of the reproductive system, including the ovaries - where eggs are produced - the fallopian tubes which carry the eggs to the uterus and the cervix - or neck of the uterus.



There are many different reasons why a doctor may recommend this kind of surgery.



In many cases, disease or the growth of abnormal tissue will lead a doctor to recommend the removal of the uterus.



In some cases, unusually heavy menstrual flow and the accompanying discomfort may make hysterectomy an important treatment option for patient and physician to consider.



But no matter what the reason behind it, you should be aware that the removal of the uterus and other reproductive organs is a serious step and it can mean significant changes in your life.



After having a hysterectomy, you will not be able to have children and if your ovaries are removed as part of the procedure, you may even need to take medication to replace hormones that your body once produced on its own.



Your Procedure



On the day of your operation, you will be asked to put on a surgical gown.



You may receive a sedative by mouth and an intravenous line may be put in.



You will then be transferred to the operating table.



The anesthesiologist will begin to administer anesthesia - most probably general anesthesia.



The surgeon will then apply an antiseptic solution to the skin place a sterile drape around the operative site.



After allowing a few minutes for the anesthetic to take effect, your doctor will decide whether to make a vertical or horizontal incision.



An incision is made cutting through the skin and muscle of the abdomen.



Next, the surgeon will inspect the general condition of the abdominal organs.



Once the ovaries are exposed the uterus can then be separated from the bladder.



Next, the fallopian tubes are tied off and cut.



All arteries and veins connected to the uterus are tied off and cut as well.



Now the uterus can be pulled upward. This stretches the vagina



allowing the surgeon to cut the uterus free at the cervix.



The surgeon closes the top of the vagina with stitches,



and provides added support by attaching the ligaments that once held the uterus in place.



The incision is then closed and a drainage tube may be left inserted at the site.



Finally, a sterile bandage is applied.



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#Hysterectomy #daVinci #reproductivehealth #endometriosis

Vaginal Hysterectomy Surgery PreOp® Patient Education and Patient Engagement

PreOp® Vaginal Hysterectomy Surgery

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• Patient Education and Patient Engagement



Your doctor has recommended a procedure, vaginal hysterectomy, to remove your uterus. 

This video is intended to help you understand this surgical treatment option. 

To start let’s review some information about your body.

The uterus is in the lowest part of the abdomen, between the hips.

 It is where a baby grows in a pregnant woman.

The cervix is the bottom of the uterus and connects it to the vagina. The cervix is also called the neck of the uterus.

The ovaries and fallopian tubes attach to the top of the uterus.  These structures are all are part of the female reproductive system, and are needed for a woman to naturally make a baby.

To better understand some of the risks of this surgery, notice that the bladder is directly in front of the cervix and vagina.

Looking at a side view of the body you can see that the uterus is behind the bladder and at the top of the vagina.

Ureters, are also next to the uterus.  They are delicate tubes that fill the bladder with urine.

The rectum is behind the vagina, it is the lowest part of your bowel.

A supracervical or partial hysterectomy is surgery to remove the uterus above the cervix.

A total hysterectomy removes the whole uterus and cervix. 

After, the ovaries and tubes are held in place by their own ligaments.

Removing an ovary is called an oophorectomy, and removing a tube is called a salpingectomy.

One or both ovaries and tubes can be removed during a hysterectomy procedure.

About 1 of 3 women have had a hysterectomy by age 60.

This number is dropping because of conservative treatment options available today.

Most conditions that can lead to a hysterectomy are not cancer, they include,

painful and/or heavy vaginal bleeding that is disrupting daily life



uterine fibroids, benign tumors of the uterus and



endometriosis, a serious cause of pelvic pain in women.



Non-invasive treatment options that may be recommended for some problems are

watch and wait, also called expectant management,



changes to diet and exercise to improve overall health



and medications to control pain, or to stop or lighten periods.



Less invasive procedures than a hysterectomy may be considered for some problems and include

endometrial ablation to treat heavy periods, a procedure that destroys the lining of the uterus



uterine artery embolization (say em-bow-liz-A-shun), used to shrink large fibroids



myomectomy to cut out fibroids and save the uterus, and



laparoscopy to look, find and treat the reason for the pain.



Removing one or both of your ovaries and tubes can be planned as part of your procedure if you have endometriosis, a known cyst or mass on your ovary, or to lower your future risk of ovarian cancer.

Unplanned removal of a tube and ovary may be necessary during surgery because

an ovary has an unexpected cyst or mass



there are adhesions making it stuck to the uterus



or there is bleeding that makes it impossible to save.



After a hysterectomy

pregnancy is not possible



you may have less estrogen, even if you keep your ovaries



you will be in menopause if the ovaries are removed.



There are three types of minimally invasive hysterectomy procedures:

 vaginal,...laparoscopic,.... and laparoscopic assisted vaginal hysterectomy also known as LAVH ( say letters L-A-V-H). 

All of these options use smaller incisions, not a classic large incision.

A vaginal hysterectomy removes the uterus and cervix through an incision in the vagina.

There are no skin incisions so recovery can be faster. There tends to be less bleeding and fewer complications than with other procedures to remove the uterus.

Sometimes a larger, open incision in your abdomen is needed for unexpected bleeding or other findings.

If this happens your hospital stay and recovery will be longer than originally planned.

Each way of removing the uterus has its own risks and benefits.

With all minimally invasive surgery the recovery is typically shorter with less pain than if an open surgery is needed. 



#CervicalHealthMonth, #CancerAware, #CervicalCancer, #hysterectomy, #womenshealth, #Menopause



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PreOp Upper GI Endoscopy, EGD Surgery - Patient Education and Patient ...

Upper GI Endoscopy, EGD - PreOp Surgery - Patient Education and Patient Engagement --- https://PreOp.com

Your doctor has recommended that you have an EGD, also known as an upper GI endoscopy.



This video will help you to understand this minimally invasive procedure.



Let’s begin by reviewing information about your body.



The gastrointestinal, GI tract, begins with the mouth.

This tract or path for digestion, continues past the throat to the esophagus, a tube that carries food to the stomach.  In the stomach, pieces of food are broken down further.   These partially digested bits then pass to the duodenum, which is the first part of the small intestine.

Together, these structures are considered the upper GI tract.



EGD  stands for the medical name of the procedure.



“E” stands for esophagus, “g” for gastro which means stomach and “d” for duodenum.



This procedure is done using a long flexible instrument called a scope, that has a light and camera at the tip.



When necessary, tools can be guided through the scope to biopsy and treat this hard to reach area of the body.





During this procedure, the lining of the upper GI tract is inspected to investigate

symptoms and complaints, such as difficulty swallowing and heartburn;

abnormal tests, commonly anemia, and,

other suspected disease, such as celiac disease, ulcers, or cancer.

Suspicious lesions may be removed or biopsied.

If tissue samples are collected, they are sent to a pathology lab for examination.



An EGD can be recommended as necessary to treat some problems.  With an EGD a doctor is often able to stop severe upper GI bleeding.

In other situations, food chunks, and other stuck objects can be reached and gently removed.

An EGD can also be used to stretch and dilate an esophagus that is narrow from scar tissue or other problems.



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#GIpath #EGD #endoscopy #gastroenterology #GI

PreOp Mesh Sling for Stress Urinary Incontinence Female

PreOp® Mesh Sling Procedure for Stress Urinary Incontinence (Female)  https://mkt.preop.com/course/mesh-sling-procedure-for-stress-urinary-incontinence-female/



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Your doctor has recommended a mesh sling to treat your stress urinary incontinence.  Before we talk about this surgical option, let’s review some information about the female body and this medical condition.



The female bladder is behind the pubic bone and on top of the vagina.   It is in the pelvis, the lowest part of the body between the hips. 



The bladder muscle squeezes to empty urine through a short tube called the urethra. This tube lies under the pubic bone and in front of the vagina.



The urethral sphincter is a muscle at the opening to the bladder.  You control urination by relaxing and squeezing this muscle.

Stress urinary incontinence , SUI is uncontrolled urine leaking from pressure on the bladder and urethra.  This pressure  happens with sneezing, coughing, laughing and exercise.   



SUI is a problem when the pelvic muscles that support the bladder and urethra, or the urethral sphincter are weak.

Support problems can start from pressure on these muscles with pregnancy and childbirth, chronic constipation, extra body weight, smoking, coughing and certain activities like heavy lifting that are repeated often. 



Other risks for female SUI include



low estrogen and menopause



genetics, meaning a woman can be born at risk for weak tissue



and it can be an occasional side effect of pelvic surgery



Some changes can make  leaking better without surgery, drink smaller amounts at a time, quit smoking if you smoke and work to get to a healthy weight if you are overweight.



Another way to help stop leaking without surgery is to make pelvic muscles stronger with Kegels, also called pelvic floor exercise.  These exercises can help before and after incontinence surgery. 



Physical therapists can help with these exercises.  They will sometimes use biofeedback therapy to test if you are exercising the right muscles.  Other tools for this therapy are electrical stimulation and vaginal weights.



If exercise and other changes have not helped stop the leaking then bulking agents may be an option.  Silicone microbeads or another material is injected into the urethra to make the wall thicker so that it closes more tightly.  Many patients are better after this but the leaking eventually returns for most. The injection may be repeated.



Bulking agents are most helpful for people with mild SUI, for patients not ready for surgery and patients that cannot or should not have surgery.



The sling procedure is a permanent surgical treatment option for women with problem leaking from SUI.



A sling is a ribbon which can be made of human tissue or plastic fabric called mesh. The ribbon is looped under the urethra during surgery, to create a sling or hammock.  This adds support for the weak tissues and urethral sphincter and helps stop leaking for most patients.



Your surgeon has recommended a mesh sling for you.  This means that your sling will be made of a ribbon of plastic fabric called polypropylene. 



The main benefits to using mesh instead of human tissue are



mesh slings are faster and easier to place



less time is spent in surgery



incisions are smaller



so healing is faster than if the sling was made from your own tissue.



Mesh slings have been used to treat SUI for over 15 years.  About 8 out of 10 women have no leaking or are drier after this procedure.   As with any surgery there can be problems or complications for some patients.



Mesh exposure in the vagina is one problem that can affect about  3 percent or 3 in 100 women after a mesh sling.  This is when a piece of the mesh is not completely covered by the vaginal wall after healing.



A small edge of the mesh can be felt by the patient or their partner as a screen or gritty patch in the vagina. This can usually be fixed with a minor procedure to trim and cover the mesh. If the exposed mesh is not causing the patient any problems, it can be safe to leave untreated, and repair if new problems develop.

Mesh exposure is more common in patients that have thin delicate vaginal tissue from low estrogen. You may be advised to use estrogen vaginal cream before or after surgery.

Rarely, the mesh causes painful scar tissue, erosion or damage to the bladder or urethra. Some problems, especially pain are not able to be fixed with surgery.



There are three main types of mesh sling procedure: mini sling, retropubic and transobturator .  Each way of placing the mesh has its own risks and benefits.



Mini Slings are the newest procedure. They use the smallest size mesh and only need one small vaginal incision to place.  But we are still learning about how well these work and the problems that patients may have.



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