smoh/medical-transcriptions huggingface dataset:
Colonoscopy with Biopsy  ( Gastroenterology)
Description:  A woman referred for colonoscopy secondary to heme-positive stools.  Procedure done to rule out generalized diverticular change, colitis, and neoplasia.

INDICATIONS FOR PROCEDURE: , A 79-year-old Filipino woman referred for colonoscopy secondary to heme-positive stools.  Procedure done to rule out generalized diverticular change, colitis, and neoplasia.,DESCRIPTION OF PROCEDURE: , The patient was explained the procedure in detail, possible complications including infection, perforation, adverse reaction of medication, and bleeding.  Informed consent was signed by the patient.,With the patient in left decubitus position, had received a cumulative dose of 4 mg of Versed and 75 mg of Demerol, using Olympus video colonoscope under direct visualization was advanced to the cecum.  Photodocumentation of appendiceal orifice and the ileocecal valve obtained.  Cecum was slightly obscured with stool but the colon itself was adequately prepped.  There was no evidence of overt colitis, telangiectasia, or overt neoplasia.  There was moderately severe diverticular change, which was present throughout the colon and photodocumented.  The rectal mucosa was normal and retroflexed with mild internal hemorrhoids.  The patient tolerated the procedure well without any complications.,IMPRESSION:,1.  Colonoscopy to the cecum with adequate preparation.,2.  Long tortuous spastic colon.,3.  Moderately severe diverticular changes present throughout.,4.  Mild internal hemorrhoids.,RECOMMENDATIONS:,1.  Clear liquid diet today.,2.  Follow up with primary care physician as scheduled from time to time.,3.  Increase fiber in diet, strongly consider fiber supplementation.
Colonoscopy & Polypectomy - 2  ( Gastroenterology)
Description:  Colonoscopy, conscious sedation, and snare polypectomy.

PREPROCEDURE DIAGNOSIS: , Colon cancer screening.,POSTPROCEDURE DIAGNOSIS:  ,Colon polyps, diverticulosis, hemorrhoids.,PROCEDURE PERFORMED: , Colonoscopy, conscious sedation, and snare polypectomy.  ,INDICATIONS:  ,The patient is a 63-year-old male who has myelodysplastic syndrome, who was referred for colonoscopy.  He has had previous colonoscopy.  There is no family history of bleeding, no current problems with his bowels.  On examination, he has internal hemorrhoids.  His prostate is enlarged and increased somewhat in firmness.  He has scattered diverticular disease of a moderate degree and he has two polyps, one 1 cm in the mid ascending colon, and one in the left transverse colon, which is also 1 cm.  These were removed with snare polypectomy technique.  I would recommend that the patient have an increased fiber diet and repeat colonoscopy in 5 years or sooner if he develops bowel habit change or bleeding.,PROCEDURE: , After explaining the operative procedure, the risks and potential complications of bleeding and perforation, the patient was given 175 mcg fentanyl, and 8 mg Versed intravenously for conscious sedation.  Blood pressure 115/60, pulse 98, respiration 18, and saturation 92%.  A rectal examination was done and then the colonoscope was inserted through the anorectum, rectosigmoid, descending, transverse, and ascending colon, to the ileocecal valve.  The scope was withdrawn to the mid ascending colon, where the polyp was encircled with a snare and removed with a mixture of cutting and coagulating current, then retrieved through the suction port.  The scope was withdrawn into the left transverse colon, where the second polyp was identified.  It was encircled with a snare and removed with a mixture of cutting and coagulating current, and then removed through the suction port as well.  The scope was then gradually withdrawn the remaining distance and removed.  The patient tolerated the procedure well.
Colonoscopy Template - 5  ( Gastroenterology)
Description:  Common description of colonoscopy
Colonoscopy & Polypectomy - 1  ( Gastroenterology)
Description:  Total colonoscopy and polypectomy

PREOPERATIVE DIAGNOSIS:,  History of colitis.,POSTOPERATIVE DIAGNOSIS: , Small left colon polyp.,PROCEDURE PERFORMED: , Total colonoscopy and polypectomy.,ANESTHESIA:,  IV Versed 8 mg and 175 mcg of IV fentanyl.,CLINICAL HISTORY: , This patient had a tough time with colitis 10 years ago and has intermittent problems with bleeding.  He has been admitted to the hospital now for colonoscopy and polyp surveillance.,PROCEDURE:  ,The patient was prepped and draped in a left lateral decubitus position.  The flexible 165 cm CF video Olympus colonoscope was inserted through the anus and passed under TV-directed monitor through the area of the rectum, sigmoid colon, left colon, transverse colon, right colon, and cecum.  He had an excellent prep.  He had a 2-3 mm polyp in the left colon that was removed with a jumbo biopsy forceps.  He tolerated the procedure well.  There was no other evidence of any cancer, growth, tumor, colitis, or problems throughout the entire colon.  His exam that he had in 1997 showed a small amount of colitis at that time and he has had some intermittent symptoms since.  Representative pictures were taken throughout the entire exam.  There was no other evidence any problems.  On withdrawal of the scope, the same findings were noted.,FINAL IMPRESSION: , Small, left colon polyp in a patient with intermittent colitis-like symptoms and bleeding.
Colonoscopy & Polypectomy - 3  ( Gastroenterology)
Description:  Total colonoscopy with biopsy and snare polypectomy.

PREOPERATIVE DIAGNOSIS:,  Alternating hard and soft stools.,POSTOPERATIVE DIAGNOSIS:,Sigmoid diverticulosis.,Sessile polyp of the sigmoid colon.,Pedunculated polyp of the sigmoid colon.,PROCEDURE: , Total colonoscopy with biopsy and snare polypectomy.,PREP:,  4/4.,DIFFICULTY:,  1/4.,PREMEDICATION AND SEDATION: , Fentanyl 100, midazolam 5.,INDICATION FOR PROCEDURE:,  A 64-year-old male who has developed alternating hard and soft stools.  He has one bowel movement a day.,FINDINGS: , There is extensive sigmoid diverticulosis, without evidence of inflammation or bleeding.  There was a small, sessile polyp in the sigmoid colon, and a larger pedunculated polyp in the sigmoid colon, both appeared adenomatous.,DESCRIPTION OF PROCEDURE: , Preoperative counseling, including an explicit discussion of the risk and treatment of perforation was provided.  Preoperative physical examination was performed.  Informed consent was obtained.  The patient was placed in the left lateral decubitus position.  Premedications were given slowly by intravenous push.  Rectal examination was performed, which was normal.  The scope was introduced and passed with minimal difficulty to the cecum.  This was verified anatomically and video photographs were taken of the ileocecal valve and appendiceal orifice.  The scope was slowly withdrawn, the mucosa carefully visualized.  It was normal in its entirety until reaching the sigmoid colon.  Sigmoid colon had extensive diverticular disease, small-mouth, without inflammation or bleeding.  In addition, there was a small sessile polyp, which was cold biopsied and recovered, and approximately an 8 mm pedunculated polyp.  A snare was placed on the stalk of the polyp and divided with electrocautery.  The polyp was recovered and sent for pathologic examination.  Examination of the stalk showed good hemostasis.  The scope was slowly withdrawn and the remainder of the examination was normal.,ASSESSMENT: , Diverticular disease.  A diverticular disease handout was given to the patient's wife and a high fiber diet was recommended.  In addition, 2 polyps, one of which is assuredly an adenoma.  Patient needs a repeat colonoscopy in 3 years.
Colonoscopy Template - 1  ( Gastroenterology)
Description:  Common description of colonoscopy
Colonoscopy - 4  ( Gastroenterology)
Description:  Colonoscopy - Diarrhea, suspected irritable bowel

PREOPERATIVE DIAGNOSIS:,  Diarrhea, suspected irritable bowel.,POSTOPERATIVE DIAGNOSIS:,  Normal colonoscopy., PREMEDICATIONS: , Versed 5 mg, Demerol 75 mg IV.,REPORTED PROCEDURE:,  The rectal exam revealed no external lesions.  The prostate was normal in size and consistency.,The colonoscope was inserted into the cecum with ease.  The cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, and rectum were normal.  The scope was retroflexed in the rectum and no abnormality was seen, so the scope was straightened, withdrawn, and the procedure terminated.,ENDOSCOPIC IMPRESSION:,  Normal colonoscopy - no evidence of inflammatory disease, polyp, or other neoplasm.  These findings are certainly consistent with irritable bowel syndrome.
Colonoscopy - 9  ( Gastroenterology)
Description:  Patient with history of polyps.

PREOPERATIVE DIAGNOSIS:,  Prior history of polyps.,POSTOPERATIVE DIAGNOSIS:,  Small polyps, no evidence of residual or recurrent polyp in the cecum.,PREMEDICATIONS: , Versed 5 mg, Demerol 100 mg IV.,REPORTED PROCEDURE:,  The rectal chamber revealed no external lesions.  Prostate was normal in size and consistency.,The colonoscope was inserted into the rectal ampulla and advanced under direct vision at all times until the tip of the scope was placed in the cecum.  The position of the scope within the cecum was verified by identification of the ileocecal valve.  Navigation was difficult because it seemed that the cecum took an upward turn at its final turn, but the examination was completed.,The cecum was extensively studied and no lesion was seen.  There was not even a scar representing the prior polyp.  I was able to see the area across from the ileocecal valve exactly where the polyp was two years ago, and I saw no lesion at all.  The scope was then slowly withdrawn.  In the mid transverse colon, was a small submucosal lesion, which appeared to be a lipoma.  It was freely mobile and very small with normal overlying mucosa.  There was a similar lesion in the descending colon.  Both of these appeared to be lipomatous, so no attempt was made to remove them.  There were diverticula present in the sigmoid colon.  In addition, there were two polyps in the sigmoid colon both of which were resected using electrocautery.  There was no bleeding.  The scope was then withdrawn.  The rectum was normal.  When the scope was retroflexed in the rectum, two very small polyps were noted just at the anorectal margin, and so these were obliterated using the electrocautery snare.  There was no specimen and there was no bleeding.  The scope was then straightened, withdrawn, and the procedure terminated.,ENDOSCOPIC IMPRESSION:,1.  Small polyps, sigmoid colon, resected them.,2.  Diverticulosis, sigmoid colon.,3.  Small rectal polyps, obliterated them.,4.  Submucosal lesions, consistent with lipomata as described.,5.  No evidence of residual or recurrent neoplasm in the cecum.
Colonoscopy - 7  ( Gastroenterology)
Description:  Patient with history of adenomas and irregular bowel habits.

PROCEDURE:,  Colonoscopy.,PREOPERATIVE DIAGNOSIS: , Follow up adenomas.,POSTOPERATIVE DIAGNOSES:,1.  Two colon polyps, removed.,2.  Small internal hemorrhoids.,3.  Otherwise normal examination of cecum.,MEDICATIONS: , Fentanyl 150 mcg and Versed 7 mg slow IV push.,INDICATIONS: , This is a 60-year-old white female with a history of adenomas.  She does have irregular bowel habits.,FINDINGS: , The patient was placed in the left lateral decubitus position and the above medications were administered.  The colonoscope was advanced to the cecum as identified by the ileocecal valve, appendiceal orifice, and blind pouch.  The colonoscope was slowly withdrawn and a careful examination of the colonic mucosa was made, including a retroflexed view of the rectum.  There was a 4 mm descending colon polyp, which was removed with jumbo forceps, and sent for histology in bottle one.  There was a 10 mm pale, flat polyp in the distal rectum, which was removed with jumbo forceps, and sent for histology in bottle 2.  There were small internal hemorrhoids.  The remainder of the examination was normal to the cecum.  The patient tolerated the procedure well without complication.,IMPRESSION:,1.  Two colon polyps, removed.,2.  Small internal hemorrhoids.,3.  Otherwise normal examination to cecum.,PLAN: , I will await the results of the colon polyp histology.  The patient was told the importance of daily fiber.
Colonoscopy - 3  ( Gastroenterology)
Description:  Colonoscopy to evaluate prior history of neoplastic polyps.

PREOPERATIVE DIAGNOSIS:,  Prior history of neoplastic polyps.,POSTOPERATIVE DIAGNOSIS:,  Small rectal polyps/removed and fulgurated.,PREMEDICATIONS:,  Prior to the colonoscopy, the patient complained of a sever headache and she was concerned that she might become ill.  I asked the nurse to give her 25 mg of Demerol IV.,Following the IV Demerol, she had a nausea reaction.  She was then given 25 mg of Phenergan IV.  Following this, her headache and nausea completely resolved.  She was then given a total of 7.5 mg of Versed with adequate sedation.  Rectal exam revealed no external lesions.  Digital exam revealed no mass.,REPORTED PROCEDURE:,  The P160 colonoscope was used.  The scope was placed in the rectal ampulla and advanced to the cecum.  Navigation through the sigmoid colon was difficult.  Beginning at 30 cm was a very tight bend.  With gentle maneuvering, the scope passed through and then entered the cecum.  The cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, and descending colon were normal.  The sigmoid colon was likewise normal.  There were five very small (punctate) polyps in the rectum.  One was resected using the electrocautery snare and the other four were ablated using the snare and cautery.  There was no specimen because the polyps were so small.  The scope was retroflexed in the rectum and no further abnormality was seen, so the scope was straightened, withdrawn, and the procedure terminated.,ENDOSCOPIC IMPRESSION:,1.  Five small polyps as described, all fulgurated.,2.  Otherwise unremarkable colonoscopy.
Colonoscopy - 6  ( Gastroenterology)
Description:  Colonoscopy to screen for colon cancer

INDICATIONS: , This is a 55-year-old female who is having a colonoscopy to screen for colon cancer.  There is no family history of colon cancer and there has been no blood in the stool.,PROCEDURE PERFORMED:  ,Colonoscopy.,PREP: , Fentanyl 100 mcg IV and 3 mg Versed IV.,PROCEDURE:,  The tip of the endoscope was introduced into the rectum.  Retroflexion of the tip of the endoscope failed to reveal any distal rectal lesions.  The rest of the colon through to the cecum was well visualized.  The cecal strap, ileocecal valve, and light reflex in the right lower quadrant were all identified.  There was no evidence of tumor, polyp, mass, ulceration, or other focus of inflammation.  Adverse reactions none.,IMPRESSION:,  Normal colonic mucosa through to the cecum.  There was no evidence of tumor or polyp.
Colonoscopy - 20  ( Gastroenterology)
Description:  Screening colonoscopy.  Tiny polyps.   If adenomatous, repeat exam in five years.  

PREOPERATIVE DIAGNOSIS: , Screening. ,POSTOPERATIVE DIAGNOSIS:,  Tiny Polyps.,PROCEDURE PERFORMED:  , Colonoscopy.,PROCEDURE:  , The procedure, indications, and risks were explained to the patient, who understood and agreed.  He was sedated with Versed 3 mg, Demerol 25 mg during the examination.  ,A digital rectal exam was performed and the Pentax Video Colonoscope was advanced over the examiner's finger into the rectum.  It was passed to the level of the cecum.  The ileocecal valve was identified, as was the appendiceal orifice.  ,Slowly withdrawal through the colon revealed a small polyp in the transverse colon.  This was approximately 3 mm in size and was completely removed using multiple bites with cold biopsy forceps.  In addition, there was a 2 mm polyp versus lymphoid aggregate in the descending colon.  This was also removed using the cold biopsy forceps.  Further detail failed to reveal any other lesions with the exception of small hemorrhoids.  ,IMPRESSION:  , Tiny polyps.  ,PLAN:  , If adenomatous, repeat exam in five years.  Otherwise, repeat exam in 10 years.,
Colonoscopy - 21  ( Gastroenterology)
Description:  Colonoscopy and biopsies, epinephrine sclerotherapy, hot biopsy cautery, and snare polypectomy.  Colon cancer screening.  Family history of colon polyps.

OPERATIVE PROCEDURES: , Colonoscopy and biopsies, epinephrine sclerotherapy, hot biopsy cautery, and snare polypectomy.,PREOPERATIVE DIAGNOSES:,1.  Colon cancer screening.,2.  Family history of colon polyps.,POSTOPERATIVE DIAGNOSES:,1.  Multiple colon polyps (5).,2.  Diverticulosis, sigmoid colon.,3.  Internal hemorrhoids.,ENDOSCOPE USED: , EC3870LK.,BIOPSIES:  ,Biopsies taken from all polyps.  Hot biopsy got applied to one.  Epinephrine sclerotherapy and snare polypectomy applied to four polyps.,ANESTHESIA: , Fentanyl 75 mcg, Versed 6 mg, and glucagon 1.5 units IV push in divided doses.  Also given epinephrine 1:20,000 total of 3 mL.,The patient tolerated the procedure well.,PROCEDURE:  ,The patient was placed in left lateral decubitus after appropriate sedation.  Digital rectal examination was done, which was normal.  Endoscope was introduced and passed through a rather spastic tortuous sigmoid colon with multiple diverticula seen all the way through transverse colon where about 1 cm x 1 cm sessile polyp was seen.  It was biopsied and then in piecemeal fashion removed using snare polypectomy after base was infiltrated with epinephrine.  Pedunculated polyp next to it was hard to see and there was a lot of peristalsis.  The scope then was advanced through rest of the transverse colon to ascending colon and cecum.  Terminal ileum was briefly reviewed, appeared normal and so did cecum after copious amount of fecal material was irrigated out.  Ascending colon was unremarkable.  At hepatic flexure may be proximal transverse colon, there was a sessile polyp about 1.2 cm x 1 cm that was removed in the same manner with a biopsy taken, base infiltrated with epinephrine and at least two passes of snare polypectomy and subsequent hot biopsy cautery removed to hold polypoid tissue, which could be seen.  In transverse colon on withdrawal and relaxation with epinephrine, an additional 1 mm to 2 mm sessile polyp was removed by hot biopsy.  Then in the transverse colon, additional larger polyp about 1.3 cm x 1.2 cm was removed in piecemeal fashion again with epinephrine, sclerotherapy, and snare polypectomy.  Subsequently pedunculated polyp in distal transverse colon near splenic flexure was removed with snare polypectomy.  The rest of the splenic flexure and descending colon were unremarkable.  Diverticulosis was again seen with almost constant spasm despite of glucagon.  Sigmoid colon did somewhat hinder the inspection of that area.  Rectum, retroflexion posterior anal canal showed internal hemorrhoids moderate to large.  Excess of air insufflated was removed.  The endoscope was withdrawn.,PLAN: , Await biopsy report.  Pending biopsy report, recommendation will be made when the next colonoscopy should be done at least three years perhaps sooner besides and due to multitude of the patient's polyps.
Colonoscopy - 22  ( Gastroenterology)
Description:  Mild-to-moderate diverticulosis.  She was referred for a screening colonoscopy.  There is no family history of colon cancer.  No evidence of polyps or malignancy.

PROCEDURE: , Colonoscopy.,PREOPERATIVE DIAGNOSES:,  The patient is a 56-year-old female.  She was referred for a screening colonoscopy.  The patient has bowel movements every other day.  There is no blood in the stool, no abdominal pain.  She has hypertension, dyslipidemia, and gastroesophageal reflux disease.  She has had cesarean section twice in the past.  Physical examination is unremarkable.  There is no family history of colon cancer.,POSTOPERATIVE DIAGNOSIS: , Diverticulosis.,PROCEDURE IN DETAIL: , Procedure and possible complications were explained to the patient.  Ample opportunity was provided to her to ask questions.  Informed consent was obtained.  She was placed in left lateral position.  Inspection of perianal area was normal.  Digital exam of the rectum was normal.,Video Olympus colonoscope was introduced into the rectum.  The sigmoid colon is very tortuous.  The instrument was advanced to the cecum after placing the patient in a supine position.  The patient was well prepared and a good examination was possible.  The cecum was identified by the ileocecal valve and the appendiceal orifice.  Images were taken.  The instrument was then gradually withdrawn while examining the colon again in a circumferential manner.  Few diverticula were encountered in the sigmoid and descending colon.  Retroflex view of the rectum was unremarkable.  No polyps or malignancy was identified.,After obtaining images, the air was suctioned.  Instrument was withdrawn from the patient.  The patient tolerated the procedure well.  There were no complications.,SUMMARY OF FINDINGS:  ,Colonoscopy was performed to cecum and demonstrates the following:,1.  Mild-to-moderate diverticulosis.,2.  ,RECOMMENDATION:,1.  The patient was provided information on diverticulosis including dietary advice.,2.  She was advised repeat colonoscopy after 10 years.
Colonoscopy - 19  ( Gastroenterology)
Description:  Colonoscopy with terminal ileum examination.   Iron deficiency anemia.  Following titrated intravenous sedation the flexible video endoscope was introduced into the rectum and advanced to the cecum without difficulty. 

INDICATION: , Iron deficiency anemia.,PROCEDURE:  ,Colonoscopy with terminal ileum examination.,POSTOPERATIVE DIAGNOSIS:,  Normal examination.,WITHDRAWAL TIME: , 15 minutes.,SCOPE: , CF-H180AL.,MEDICATIONS: , Fentanyl 100 mcg and versed 10 mg.,PROCEDURE DETAIL:  ,Following the preprocedure patient assessment the procedure, goals, risks including bleeding, perforation, missed polyp rate as well as side effects of medications and alternatives were reviewed.  Questions were answered.  Pause preprocedure was performed.,Following titrated intravenous sedation the flexible video endoscope was introduced into the rectum and advanced to the cecum without difficulty.  The ileocecal valve looked normal.  Preparation was fair allowing examination of 85% of mucosa after washing and cleaning with tap water through the scope.  The terminal ileum was intubated through the ileocecal valve for a 5 cm extent.  Terminal ileum mucosa looked normal.,Then the scope was withdrawn while examining the mucosa carefully including the retroflexed views of the rectum.  No polyp, no diverticulum and no bleeding source was identified.,The patient was assessed upon completion of the procedure.  Okay to discharge once criteria met.  ,RECOMMENDATIONS:,  Follow up with primary care physician.