Tag Archives: patient care

Novel, Minimally-Invasive Approach to Life-threatening, Complex Hepatic Abscess

In 2014, the world’s first percutaneous endoscopic debridement of hepatic abscesses was successfully performed by Matthew T. Moyer, M.D., at Penn State Hershey Medical Center. A report of the case was recently published in Gastrointestinal Endoscopy.¹ And, last October, a video of the procedure won first place in the international video forum competition at the 2014 American College of Gastroenterology Annual Conference in Philadelphia.2

Case SummaryIn a novel approach to treat a patient with life-threatening and complex hepatic abscess, Moyer explains that a multidisciplinary approach involving gastroenterologists, surgical oncologists and interventional radiologists was important, and that the approach was built on established principles of endoscopic treatment of pancreatic necrosis.3 “The successes that our interventional endoscopy group has had with endoscopic ultrasound-guided drainage and stenting of pancreatic pseudocysts as well as transluminal endoscopic debridement and washout of pancreatic abscess and necrosis inspired us to attempt adapting the technique to this patient as an alternative to high-risk open or laparoscopic hepatic necrosectomy, where mortality can be as high as 15 percent.” Continue reading

Leave a comment

Filed under Patient Care, Treatments

Pelvic Floor Disorders: Common, Undetected Problems

Pelvic floor disorders are the “Don’t Ask, Don’t Tell” of gastroenterology, colorectal surgery and urogynecology. “Patients don’t volunteer information about urinary incontinence, fecal or anal incontinence, or constipation.

Likewise, most physicians don’t ask the detailed questions needed to make the correct diagnosis,” says Deborah Bethards, M.D., of Penn State Hershey Gastroenterology and Hepatology. Bethards says, “These disorders are seen even among active younger women. A recent study showed that over one-third of female triathletes had at least one pelvic floor disorder symptom.”

According to this report, 37 percent of the women experienced anal incontinence.1 These data indicate that physicians should have pelvic floor problems high on their radar. To increase detection, Bethards stresses the importance of asking the appropriate questions. “A complaint of ‘constipation’ is an opportunity to ask about chronicity, frequency, stool characteristics, whether they strain or sit for a long time, and if they feel incomplete evacuation. Different symptoms point to distinctly different problems such as dyssynergic defecation, which can be found in up to 50 percent of patients referred to tertiary care centers for chronic constipation.2 These are problems that a change in diet or even medication won’t really address,” says Bethards. Continue reading

Leave a comment

Filed under Disorders, Patient Care, Treatments

Expanding the Role of Medical Simulation Technology in Medical Digestive Health Student Training

Long before they are admitted to medical school, students have well-honed studying and testtaking skills. But they often lack the skills needed to apply what they’ve learned in the classroom to the clinical setting. Emmanuelle D. Williams, M.D., director of gastroenterology training for second-year medical students for Penn State Milton S. Hershey Medical Center’s Division of Gastroenterology and Hepatology, is working to change that.

“At Penn State Hershey, all of our second-year medical students (currently more than 140) are required to participate in handling initial intake of a simulated ‘patient’ who presents to the emergency department with a gastrointestinal bleed,” said Williams. The case builds directly on classroom lectures about obtaining a medical history, monitoring vital signs and differential diagnosis.

“It’s usually a very emotional experience for the students,” said Williams. “The clinical routine begins to fall apart; they don’t get a proper history, they struggle with differential diagnosis, and professionalism is lacking. It opens their eyes to the difference between book learning and applying that knowledge in the clinic.” Continue reading

Leave a comment

Filed under Education, Patient Care

Coordinated GI Cancer Care from Diagnosis to Long-term Survival

Gastrointestinal (GI) cancers are among the most complex malignancies to treat; often, patients present with advanced disease and survival rates tend to be low. In 2005, a small group of hepatobiliary surgeons at Penn State Hershey Medical Center came together and formed the Liver, Pancreas, and Foregut Tumor Program to deliver state-of-the-art, multidisciplinary care for this difficult to treat patient population. The group has grown over the years to include four hepatobiliary surgeons: Kevin Staveley O’Carroll, M.D., Ph.D., director of the Liver, Foregut and Pancreas Program; Niraj J. Gusani, M.D., M.S., F.A.C.S.; Jussuf T. Kaifi, M.D., Ph.D.; and Eric T. Kimchi, M.D., F.A.C.S.

The multidisciplinary and coordinated nature of the program is unique to the central Pennsylvania region. Patients admitted into the program receive coordinated care from a team of surgeons, gastroenterologists, hepatologists, medical oncologists, radiation oncologists, radiologists, geneticists, and psychiatrists. Diagnostic questions are optimally clarified by modalities such as endoscopic ultrasound and computed tomography, with expert gastrointestinal pathologists providing immediate interpretation when biopsy procedures are necessary, resulting in high diagnostic accuracy with less repeat procedures. Such facets of the program allow surgeons to optimally address the challenges of tumor removal in these cases. Continue reading

Leave a comment

Filed under Education, Treatments

Addressing Patient Nutritional Needs in Complex Abdominal Surgery and Intestinal Failure

The pre-treatment nutritional status of patients with acute abdominal injury, or chronic gastrointestinal (GI) illness plays a large role in post-surgical course of recovery. Likewise, their ability to obtain nutrition after treatment significantly impacts long-term health outcomes and quality of life.

David Soybel, M.D.

Physicians at Penn State Hershey Medical Center and Penn State College of Medicine are investigating how to better detect and address nutritional needs before and after major complex GI surgery. According to David Soybel, M.D., “A significant proportion of patients with complex medical histories have pre-existing deficiencies in specific micronutrients such as zinc, copper, selenium, and magnesium. Major procedures place high demands on already compromised micronutrient stores, and often put these patients into a state of ‘micronutrient distress’ that may be associated with longer and more complicated recovery.”

Soybel’s research aims to establish methods to routinely detect and treat these deficiencies in high-risk patients, both before and after surgery. “Pre-surgical recognition of micronutrient deficiencies would provide the opportunity for micronutrient repletion and other interventions, and better prepare patients to get well post-surgery,” says Soybel. “Likewise, in acute situations, recognition of such deficiencies and rapid intervention could help patients better recover after emergency procedures.”

Gordon Lee Jensen, M.D., Ph.D.

Based in State College and one of few physicians in the country who specializes in management of intestinal failure, Gordon Lee Jensen, M.D., Ph.D., explains, “In the past, many of these intestinal failure patients would have died or become indefinitely dependent on intravenous, total parenteral nutrition (TPN). But now, because of new medications and advances in medical nutrition therapy, some can eventually come off of TPN and lead more normal lives. Today, TPN is more often a temporary supportive measure. Successful transition off of TPN depends on a number of factors. If a patient has at least 100 cm of small bowel length and a portion of intact colon (or at least 150 cm of small bowel and no functional or intact colon), and residual disease is controlled, then the odds are favorable for them to eventually adapt to enteral or oral nutrition.” Continue reading

Leave a comment

Filed under Education, Treatments

IBD Center Advances Toward Official Announcement

Inflammatory bowel disease (IBD), has increasingly been a focus of clinical attention at Penn State Hershey Medical Center. The multidisciplinary care needed by these patients has brought together surgeons, gastroenterologists, radiologists, nutritionists, and other sub-specialists to foster the creation of an IBD center focused on providing excellence in IBD patient care and promoting access to cutting-edge research and treatments. This initiative has been directed by Walter Koltun, M.D., F.A.C.S., F.A.S.C.R.S., chief, Division of Colon and Rectal Surgery, and Emmanuelle Williams, M.D., assistant professor of medicine. Koltun explains, “The Penn State Hershey IBD Center has three major components that include a multidisciplinary patient care clinic where surgeons and gastroenterologists see patients together; educational and training programs for both medical professionals and patients; and, an IBD research program that includes benchtop basic science and clinical trials of new, investigative treatments.”
Continue reading

Leave a comment

Filed under Disorders, Education, Treatments