4 Hospital Procedures

1. Jennifer Jimenez

2. WHAT IS SERUM
BILIRUBIN?
Serum Bilirubin is a “diagnostic procedure” meaning that it is a test to
determine a possible diagnosis
Bilirubin is a product of the breakdown of red blood cells. Which means
it’s made when the hemoglobin protein in old red blood cells is broken
down.
Blood tests are done to determine how much waste product bilirubin is
in your bloodstream.
When there are elevated levels, it may indicate liver disease or other
complications in your body.

3.  Chol/e=bile, gall
 Cholecyst/o
 Cholangi/o=bile duct
 Choledoch/o=common bile duct
 Duoden/o=duodenum
 Enter/o=small intestine
 Hepat/o=liver

4.  Normally, old blood cells (senescent
erythrocytes) produce enzymes that form
bilirubin, in which it is then passed into the
liver (part of the lymphatic/immune system)
and in a liver cell where it forms into a water
soluble form. In the liver, it’s mixed with the
bile and eventually it’s excreted through the
bile ducts and stored in the gal bladder. Then
it’s released into the small intestine to help
digest fats…

5.  Bilirubin abnormalities can lead to:
 Jaundice (yellowing of the skin,
eyes).
 Detecting increased destruction of
red blood cells.
 Check for abnormalities in your
liver.
 Help determine if you have
developed any disorders such as
hemolytic anemia.

6.  Before the test is done, a doctor or whoever
performs the test will tell you not to eat or
drink anything but water at least a few hours
prior to testing
 To do this test the doctor or hematologist
needs to take out a bit of blood from a vein in
our arm.
 Once this is done, it will be taken into a lab
for testing…
 These are normal results according to an
article by Allina health:
 Adults: 0.3 to 1 mg/dL
 Children 6 days to 18 years: 0.3 to1.2
mg/dL
 Premature infants, cord blood: <2 mg/dL

7. WHAT IS AN
HERNIOPLASTY
 A Hernioplasty is a type of
“therapeutic procedure”
 It can also be referred to as a
“herniorrhaphy”
 It is the surgical repair of an
hernia

8.  -plasty= surgical repair
 -al – pertaining to
 -algia= pain
 Ex-= outward
 -osis = abnormal condition
 Lapar/o=abdomen

9.  Most hernia’s occur in the abdomen area.
 There are many types of hernia’s, the most common type according
to healthline is an inguinal hernia, they occur in the lower
abdominal area in the inguinal canal. This canal is found in the
groin area. In men this cord holds the testicles up, in women, it
holds the uterus in place.
 Sometimes, an organ pushes through an opening in the
muscle/tissue that was holding it in place. This can be due to
certain types of muscle weaknesses or excessive strain. This can
lead to many complications and may be painful.
 Some factors that put you at higher risk include:
 Being pregnant
 Constipated
 Heavy lifting
 Fluid in your abdomen
 Fast weight gain
 Lots of coughing or sneezing
 An example of an hernia by Healthline is how an intestine can
break through a weakened area in the abdominal wall.

10. SYMPTOMS OF AN HERNIA
Pain
Weakness
Burning, gurgling where the buldge is
Acid reflux
Chest pain
Hard time swallowing
Sometimes you get no symptoms.

11.  For an hernia that’s in the groin area, like the one
discussed in the previous slide, an incision is made in
the lower abdominal area where the bulge is
 According to an article by webmd, there are two
types, a direct hernia: if the hernia is bulging
out, it is pushed back into place, and an indirect
hernia: if it is going down the inguinal canal,
the sac is pushed back or tied off and removed.
 The weak spot the hernia bulges through is
repaired by sewing the edges of the undamaged
muscle tissue over it. For this case, “mesh
patches of synthetic material are now being
widely used to repair hernias (hernioplasty).”
 A lot of people who had the repair done are able
to go home the same day, recovery time is
usually a few weeks.
 Swelling over the treated area is common,
just like in any surgery there is risk of
infection

12.  Anastomosis is a type of therapeutic
procedure
 It is a surgical procedure where you
connect two organs or vessels that were
separated due to another reason, such as
how the picture to your right illustrates.

13.  -osis= abnormal condition
 Re-=again
 Viscer/o= internal organs
 Ex-= outward
 Lapar/o=abdomen
 Organ/o= organ

14.  This procedure is done because sometimes a piece of organ such as a cancerous portion of the colon etc. must be
removed, the remaining two parts must come back together.
 Some indications for intestinal anastomosis “can be broadly divided into two categories: restoration of bowel
continuity… and bypass of unresectable diseased bowel”
 Ressection:
 Ressection:
 Malignancy
 Bowel gangrene
 Benign conditions (like roundworm infestation)
 Infections
 Traumatic visceral perforations
 Inflammatory bowel disease and more...
 Complications include:
 Anastomotic leak (where there is a leak)
 Bleeding
 Infection (like in many surgical procedures)
 Anastomic stricture (narrowing/ scarring) (usually after a colorectal surgery)

15.  In an intestinal anastomosis according to two e-medicine
articles:
 An incision is made (It’s usually a midline incision)
 Self retaining retractors are used for exposure
 Sometimes the patient is placed in Trendelenburg position to
displace small loops away from the pelvis
 The bowel is mobilized, usually by dividing the lateral
peritoneal reflection, then the mesentery is divided and
ligated, next the bowel is divided by clamping and making
an incision with a knife.
 A hand-sewn or stapled anastomosis is done to connect the
two remaining portions.
 A great extremely in depth article/journal on how to perform a
microvascular anastomosis can be found here:
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1214708/
 This article goes over things such as tools and what
they're used for and methods surgeons take in preparing
for this procedure

16.  A colonoscopy is a diagnostic procedure which means
it’s used to find possible diagnoses
 It is also an endoscopic procedure which means that
an instrument is used to view the inside of your colon.

17.  Colon/o = colon
 -scope= instrument to view
 -scopy= process of viewing
 gastr/o=stomach
 -al= pertaining to
 Polyp/o= polyp
 Proct/o= rectum and anus
 Hist/o=tissue

18.  It is used to diagnose things such as:
 Ulcers
 Tumors
 Colon polyps
 Helps find inflamed or bleeding areas

19.  A colonoscopy let’s doctors look at the inner lining (the
innermost layer is called the mucosa, here it lacks villi) of
your large intestine (last section of your gastrointestinal
tract and part of the digestive system) It absorbs water
and vitamins and coverts digested food into feces.
 For this procedure, a colonoscope is used, it is a “thin,
flexible tube that ranges from 48inches to 72 inches long.
A small video camera is attached to the colonoscope for
viewing.
 Before the procedure, your colon must be cleaned out.
There are different methods of doing this, which usually
include inducing stools by taking a special solution and
drinking clear fluids.
 The doctor, most likely a gastroenterologist will give you
some kind of sedative to put you out. Most patients are
lied on their left side with their knees pulled close to their
abdomen.
 The colonoscope is then inserted into the anus, moved
through the rectum and into the colon, next air will be
used to inflate the colon to get a better view.
 If a biopsy needs to be done, the doctor might use other
tools like swabs or forceps to collect the tissue samples or
take out growths, tumors or polyps.
 Risks apply to this, like any other procedures, some
include tearing of the anus when the scope is inserted,
vomiting, swelling in the abdomen and/or heavy rectal
bleeding.

20.  "Bilirubin test Why it's done." Mayo Clinic. Mayo Foundation for Medical
Education and Research, 13 Oct. 2015. Web. 25 June 2017.
 Case-Lo, Christine. "Bilirubin Blood Test." Healthline. Healthline Media, 03 Mar.
2017. Web. 25 June 2017.
 "Bilirubin, Total Measurement ." Bilirubin, total measurement. Allina Health,
29 Mar. 2016. Web. 25 June 2017.
 Wint, Carmella, and Valencia Higuera. "Hernia." Healthline. Healthline
Media, 20 Oct. 2015. Web. 25 June 2017.
 "Open Inguinal Hernia Repair (Herniorrhaphy, Hernioplasty)." WebMD.
WebMD, n.d. Web. 25 June 2017.
 "Intestinal Anastomosis." Practice Essentials, Background, Indications.
N.p., 08 Sept. 2016. Web. 25 June 2017.
 "Intestinal Anastomosis Technique." Intestinal Anastomosis Technique:
Approach Considerations, Incision and Exposure, Bowel Resection.
N.p., 08 Sept. 2016. Web. 26 June 2017.
 "Colonoscopy." WebMD. WebMD, n.d. Web. 26 June 2017.
 "Large Intestine." InnerBody. N.p., n.d. Web. 26 June 2017.

21.  https://legacy.owensboro.kctcs.edu/gcaplan/anat2/histology/rbc4.jpg (picture)
 http://www.mayoclinic.org/tests-procedures/bilirubin/basics/why-its-done/prc-20019986
 https://image.slidesharecdn.com/catabolismofheme-140325105259-phpapp01/95/catabolism-of-heme-
4-638.jpg?cb=1395745053 (picture)
 https://s-media-cache-ak0.pinimg.com/736x/fd/37/4d/fd374deea59f7fd8c66a66aafbc1b023.jpg
(picture)
 http://www.healthline.com/health/bilirubin-blood#overview1
 https://www.allinahealth.org/CCS/doc/Thomson%20Consumer%20Lab%20Database/49/150033.htm
 http://www.qmedicine.co.in/top%20health%20topics/J/images/demo/Jaundice%20.jpg (Picture)
 https://www.alphalabs.co.uk/media/catalog/product/resize/210x210/4/1/419-73295.jpg (picture)

22.  http://www.healthline.com/health/hernia#causes3
 http://img.medscapestatic.com/pi/meds/ckb/98/25598tn.jpg (picture)
 http://www.webmd.com/digestive-disorders/open-inguinal-hernia-repair-
herniorrhaphy-hernioplasty
 https://i.ytimg.com/vi/ui_4A3WpKcE/hqdefault.jpg (picture)
 https://image.slidesharecdn.com/operativesurgery-141202180539-conversion-
gate01/95/operative-surgery-ppt-mbbs-students-58-638.jpg?cb=1423262776
(picture)
 http://afairgo.net/wp-content/uploads/2014/06/inguinal-canal.jpg (picture)
 http://media.indiatimes.in/media/photogallery/2014/Mar/1542355_1437675142.jpg
(picture)

23.  https://s-media-cache-
ak0.pinimg.com/originals/5f/d3/bf/5fd3bf2e02d1c8935fe7799b6d4781a4.jpg
(picture)
 http://emedicine.medscape.com/article/1892319-overview
 http://emedicine.medscape.com/article/1892319-technique#c3
 http://images.locanto.net/1416204871/Last-Chance-To-Book-Your-MBBS-Seat-In-
Vydehi-Medical-College_6.jpg (picture)

24.  http://www.webmd.com/colorectal-cancer/colonoscopy-16695#1
 http://www.innerbody.com/anatomy/digestive/large-intestine#full-description
 http://www.innerbody.com/anatomy-images/Large-Intestine.png
 https://i1.wp.com/befitz.com/wp-content/uploads/2016/08/Colonoscopy.png?resize=363%2C363
(picture)
 http://www.gastromedicine.com.au/media-files/2015/10/col15.jpg (picture)
 http://womensvoicesforchange.org/wp-content/uploads/2013/03/Screenshot_3_21_13_8_26_AM.jpg
(picture)
 http://www.medthical.com/uploads/2/3/7/3/23733606/4414936_1_orig.jpg (picture)
 http://eastsideendoscopy.com/images/stories/Pictures/Colonoscopy1.jpg (picture)

25. THE
END