Cormier, Ian

Henderson, Brett

Keim, Lauren M.

Mailliard, Mark

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Volume 2 Issue 1 Article 62 September 2020 Acute Colonic Ischemia Secondary to Oral Contraceptive Use Lauren Keim et al. Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Keim, L. Acute Colonic Ischemia Secondary to Oral Contraceptive Use. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1). https://digitalcommons.unmc.edu/gmerj/vol2/iss1/62 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Acute Colonic Ischemia Secondary to Oral Contraceptive Use Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol2/iss1/62 Graduate Medical Education Research Journal54 Poster Presentations*Names in bold type indicate presenting author.	the clot and revealed extensive compression of the proximal left common iliac vein by the right common iliac artery suggestive of May-Thurner syndrome. Intravenous heparin anticoagulation was initiated and apixaban held, but there was suspicion for development of heparin induced thrombocytopenia so he was transitioned to argatroban for anticoagulation.Methods: Physical Exam, Doppler Ultrasound, CT Angiography Conclusion: To manage May-Thurner syndrome he underwent manual thrombectomy with endovascular stent placement. The following night he developed worsening pain and swelling in his left leg consistent with compartment syndrome. He underwent four compartment fasciotomy and was restarted on argatroban. Repeat Doppler ultrasound revealed recurrence of extensive left lower extremity DVT. Given multiple recurrent DVTs despite adequate anticoagulation, dedicated peripheral blood smear was obtained and revealed atypical myeloblasts concerning for acute myeloid 	marrow biopsy, he was started on induction chemotherapy. He remained in hospital receiving ongoing chemotherapy after residual disease was detected on bone  marrow biopsy following initial chemotherapy cycles. https://doi.org/10.32873/unmc.dc.gmerj.2.1.059Vanishing Bile Duct Syndrome: A Paraneoplastic Phenomenon Secondary to Occult Hodgkin’s LymphomaLauren M. Keim1, Ian Cormier11University of Nebraska Medical Center, Department of Internal MedicineMentor: Marco Olivera-MartinezProgram: Internal MedicineType: Case ReportBackground: A 27-year-old female with no medical history presented with one month of progressively worsening jaundice and a 30-pound weight loss. She was found to have conjugated hyperbilirubinemia with an acute cholestatic hepatitis. Ultrasound of the liver was unremarkable and magnetic resonance cholangiopancreatography revealed normal appearing intrahepatic and extrahepatic bile ducts without mechanical obstruction. An extensive workup for autoimmune and infectious etiologies of hepatitis was unremarkable. A liver biopsy 	ductopenia suggestive of vanishing bile duct syndrome (VBDS). A computed tomography scan of the chest revealed a large complex anterior mediastinal mass with extensive lymphadenopathy (Figure 1). A core needle biopsy of the right supraclavicular lymph node was obtained, and pathology was consistent with Hodgkin's lymphoma. She was initiated on induction therapy with improvement in her liver enzymes.Methods: Ultrasound, CT scanConclusion: VBDS refers to a group of disorders with variable etiologies that cause a progressive destruction of intrahepatic bile ducts with resulting cholestatic liver injury. The diagnosis is made pathologically and requires a paucity of interlobular bile ducts, a bile duct on biopsy. Etiologies include infections, ischemia, autoimmune conditions, drug reactions, and malignancy. Treatment depends on the underlying cause and includes withdrawal of offending medications, immunosuppression, ursodeoxycholic acid, and treatment of malignancy in patients with paraneoplastic VBDS. Those with irreversible hepatic failure should be considered for liver transplantation. Prognosis is variable as some progress to cirrhosis and others have regeneration of biliary epithelium with recovery of hepatic function. https://doi.org/10.32873/unmc.dc.gmerj.2.1.061Acute Colonic Ischemia Secondary to Oral Contraceptive UseLauren M. Keim1, Ian Cormier1, Brett Henderson2, Mark Mailliard21University of Nebraska Medical Center, Department of Internal Medicine  2University of Nebraska Medical Center, Department of Internal Medicine, Division of GastroenterologyMentor: Mark MailliardProgram: Internal MedicineType: Case ReportBackground: A 39-year-old female presented with sudden onset of abdominal pain and hematochezia. Her medical history was abdomen was tender to palpation in the left lower quadrant without rigidity. Workup 	!"#!for gastrointestinal pathogens, including 	$performed and revealed a diffusely edematous, ulcerated and violaceous segment of the sigmoid colon concerning for severe ischemic injury (Figure 1). Biopsies of the mucosa %ischemic colitis. Review of medications was !was discontinued due to suspicion for drug induced colonic ischemia. The patient’s hematochezia and abdominal pain resolved with conservative treatment.Methods: Physical Exam, Colonoscopy Conclusion: When young adults present with &%	%"bowel disease, and hemorrhoids are commonly considered. However, intestinal ischemia is an important differential diagnosis. Ischemic colitis is the most common form of intestinal ischemia, generally encountered in patients greater than 50 years old as a result of nonocclusive hypoperfusion. Rarely, ischemic colitis may result from drug exposure. Mesenteric thrombotic events linked to contraceptive medications have been described in the literature and are thought to be secondary to a hypercoagulable Figure 1. Computed tomography scan of the chest demonstrating large anterior mediastinal mass.Sept. 2020  |  Vol. 2  |  Issue 1 Poster Presentations 55*Names in bold type indicate presenting author.state. Several medications, including hormonal therapies, constipation inducing drugs, laxatives, and illicit drugs have been associated with ischemic colitis. Taking a thorough medication history is essential  when a patient is diagnosed with ischemic colitis. The recognition of medication  induced colonic ischemia and prompt discontinuation of offending agent is vital to patient outcomes. https://doi.org/10.32873/unmc.dc.gmerj.2.1.060Rural Otolaryngology – A Review of Resident Education and the Impact on Future Practice Selection Lauren Klute1, Christie Barnes1, Matthew Johnson1,2, Kari Nelson31 University of Nebraska Medical Center, Department of Otolaryngology  2Ear, Nose and Throat Physicians of Kearney, Kearney, NE 3University of Nebraska Medical Center, Department of Graduate Medical EducationMentor: Christie BarnesProgram: OtolaryngologyType: Original ResearchBackground: The University of Nebraska Medical Center, Department of Otolaryngology – Head and Neck Surgery (OHNS) established a rural residency rotation in Kearney, Nebraska, in 2016. Each resident spends two months on the service as a junior (years two or three), and two *	!+/been cited that residency rotations in rural of family practice and surgical physicians, however, there is not similar data available for Otolaryngology. This study provides data from current and prior OHNS residents on their rural rotation experience and the factors that contributed to future practice decisions.Methods: In this qualitative study, we used a semi-structured interview guide to probe rural rotation participants on their experience and "			practice decisions.Results: 	"	residents’ selection of future practice and did encourage residents to pursue rural practice. 	autonomy, diversity of cases, education in the private practice environment, and improved quality of life. The disadvantages included time away from family.Conclusion: The University of Nebraska Medical Center OHNS Rural Rotation provides invaluable experience, education, "	in the selection of future practices and encouraged several residents to pursue rural Otolaryngology practices. A rural rotation experience in residency may lead to retention of Otolaryngologists for rural areas. https://doi.org/10.32873/unmc.dc.gmerj.2.1.062															 Problem and Creating GuidelinesDavid J. Kusin1, Emily A. Boes2, Zachary C. Bailey1, Erin L. Stockwell1, Ryan E. Miller3, Kaeli K. Samson4, Sara M. Putnam1, Justin C. Siebler1,  Matthew A. Mormino11University of Nebraska Medical Center, Department of Orthopaedic Surgery and Rehabilitation 2University of Nebraska Medical Center, College of Medicine  3Loma Linda University Medical Center 4University of Nebraska Medical Center, College of Public Health, Department of BiostatisticsMentor: Matthew A MorminoProgram: Orthopaedic Surgery and RehabilitationType: Original ResearchBackground: About 80% of the global supply of opiates is consumed in the United States, 	morbidity and safer approaches to pain control exist1-15. The purpose of this two-part study is to quantify our opioid prescribing practices and to formulate guidelines for safe and effective opioid stewardship.Methods: The quantity of opioids prescribed (as Morphine Milligram Equivalents) at discharge and in the 90 days after surgery in adults with operatively treated, isolated fractures was correlated to patient demographics, comorbidities, fracture characteristics, and patient reported pain control.Results: There were 56 males (47%) and 63 females (53%). Ankle fractures were the most common injury (34.2%). 9 (7.6%) fractures were open. The mean VAS pain scores at the !!4.1 and 3.4, respectively. The mean initial quantity of opiates prescribed for all patients was 390 MME and the mean total quantity was 535 MME (range 60-1800, Stdev 256; 60-2550, Stdev 245, respectively). 44%=Figure 1. Colonoscopy demonstrating a diffusely edematous, ulcerated, and violaceous segment of the sigmoid colon

Acute Colonic Ischemia Secondary to Oral Contraceptive Use

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Acute Colonic Ischemia Secondary to Oral Contraceptive Use

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