11/29/2024

Student Research - Revisiting Student Posters Presented at the 2024 OAPA Annual Conference

The Ohio Association of Physician Assistants (OAPA) recognizes the importance of promoting research in the PA profession. In response to this demand, we provided a platform to display the work of Ohio PA students at the OAPA Annual Conference. These three student research posters were featured at this year's event:

Kickstart Healthy Hearts

Author:
Rachael Bauer, PA-S, Mount St. Joseph University

Co-Authors:
Mara Prickett, PA-C, Mount St. Joseph University
Jen Garrett, PA-C, Mount St. Joseph University

Purpose:
The objective of the “Kickstart Healthy Hearts” project is to bring awareness of health, wellness, and the PA profession to the children of a medically underserved local community in an educational and creative way.

Methodology:
Interactive stations were created and staffed by PA students to educate children and families regarding the anatomy of the heart as well as ways to ensure a healthy heart throughout a lifetime. Stations included:

1. A game educating the participants on heart healthy food options
2. Sharing of heart healthy foods/beverages
3. Education on heart anatomy and basic physiology as well how proper use of a stethoscope. This station also brought awareness of the Physician Assistant Profession.
4. Exercise station which provided education to participants on simple activities to increase exercise

Participants were asked to complete a brief survey upon completion (administered in English and Spanish utilizing a 5-point Likert scale).

Results:
The feedback from the Santa Maria Health Fair organizers was extremely positive as “Kickstart Healthy Hearts” was asked to return in the future. Data from 96 participants was analyzed noting that 90.5% of the participants agreed or strongly agreed that they learned more about the PA profession and 91.9% agreed or strongly agreed that they had more resources to help them with their overall health. A follow up email from the coordinator of the health fair did note qualitatively that the project was “the highlight of the event.”

Conclusion:
This project created such a great impact on the community and community members in a local medically underserved area of Cincinnati. “Kickstart Healthy Hearts” was truly unique, being the only booth containing activities for children through adulthood. “Kickstart Health Hearts” allowed us to Be the CHANGE* and set an example to others in the healthcare profession on the importance of giving back to the community. The project aimed to engage those in the PA profession, especially the future PAs who volunteered at this event to continue this legacy and to be cognizant of appropriate patient education.

An Unusual Cause of Bowel Obstruction: A Case Study

Author:
Zoe Le, Ohio University Division of PA Practice, Dublin Campus

Co-Author:
Jeff Vasiloff, MD, MPH, Ohio University Division of PA Practice, Dublin Campus

Purpose:
Entrapment of a segment of bowel by intraperitoneal adhesions or the walls of a hernia sac are, by far, the most common causes of small bowel obstruction (SBO). However, when evaluating patients with SBO, it is important to keep an open mind as to underlying etiology. Without an open mind, it is possible to miss a rare cause of SBO such as gallstone ileus, which requires its own specific treatment.

Methodology:
DG was a 65-year-old male who presented with a 3-day history of abdominal pain, nausea, and vomiting. He described the pain as periumbilical and intermittent. However, on the day before admission, the pain became progressively worse and constant. He denied fever or any recent bowel movements. He had no history of prior surgeries. He also denied smoking, drinking, and illicit drugs. On physical exam, he was an elderly man in mild acute distress secondary to pain. T was 99.4°F; P 96 per minute; respirations 20 per minute; blood pressure 108/64; and SpO2 95%. He was alert and oriented but complained of abdominal pain. His abdomen was slightly distended and was diffusely tender to palpation, but he had no rebound tenderness. His mucous membranes were dry, but the rest of the exam was unremarkable.

Results:
He was given 2 liters of IV normal saline as well as IV morphine for pain. White blood cell count was 18,900 per microL (4,000-11,000); creatinine was 1.5 mg/dL (0.6-1.3); BUN was 28 mg/dL (6-24); AST was 113 IU/L (15-40); ALT was 132 IU/L (15-50); and total bilirubin was 2.7 mg/dL (0.6-1.3). Lactate was 4.2 mmol/L (0.5-1.8). Other labs were normal. Abdominopelvic CT revealed dilated small bowel with an especially dilated area which contained three apparent gallstones.

Conclusion:
After the diagnosis of gallstone ileus was made, he was given IV ceftriaxone and metronidazole and prepped for an open laparotomy. Though much of the jejunum was dilated there were no perforations or necrosis. There was an obvious enlargement in the distal jejunum that harbored palpable gallstones. Thus, the bowel was opened by enterotomy and three gallstones were removed, one about the size of a golf ball. The bowel was closed after performing a Heineke–Mikulicz strictureplasty. Postoperatively, the patient did well. He was begun on clear liquids and tolerated advancement of diet without difficulty. His abdominal distension had resolved and postoperative pain was easily controlled. All abnormal preoperative lab results returned to normal prior to discharge. He will undergo elective laparoscopic cholecystectomy in the next few months. Gallstone ileus is an infrequent cause of SBO, occurring in only 1 of 200 patients with cholelithiasis. It usually occurs in older patients and in the past, was often unsuspected before laparotomy. However, current CT imaging can sometimes establish the diagnosis as in this case. It is important to consider the full etiologic differential diagnosis in all cases of small bowel obstruction.

Ogilvie Syndrome as a Post-Operative Complication: Case Study

Author:
Noah Cross, Ohio University Division of PA Practice, Dublin Campus

Co-Authors:
Jeffrey R. Fisher, PA-C, DMSc, DFAAPA, Ohio University Division of PA Practice, Dublin Campus
Jeff Vasiloff, MD, MPH, Ohio University Division of PA Practice, Dublin Campus

Purpose:
Ogilvie syndrome is a condition that sometimes occurs in postoperative patients. It is also known as acute colonic pseudo-obstruction. In this condition, the large intestine becomes dilated but without actual physical or mechanical obstruction. Nevertheless, it is important not to miss this diagnosis because it can lead to dire complications, some of which can be fatal.

Methodology:
JR was a 87-year-old Caucasian woman who presented to the ED after a fall while climbing the stairs into her house. She was alert and oriented at presentation, and initial examination revealed only an abrasion on her scalp and tenderness along her thoracic spine. After secondary assessment it was decided to image the chest and thoracic spine with CT. This revealed both a right-sided pneumothorax and a compression fracture of T9. She was admitted to the Trauma service where both Neurosurgery and Thoracic surgery were consulted.

Results:
Neurosurgery felt the fracture was unstable and she was taken to the OR for a T6-T12 fusion. A 32R French chest tube was also placed. The chest tube initially drained 500 ml of fluid but after two days was pulled. On rounds three days after surgery, she was found to have mild abdominal distension. It was also noted that she had yet to have a bowel movement since admission. KUB revealed huge dilation of both the ascending and transverse colon. The ascending colon measured 13 cm in diameter while that of the transverse was 9 cm. There were no air fluid levels or transition points to suggest mechanical small or large bowel obstruction. She was given the presumptive diagnosis of Ogilvie syndrome and gastroenterology was consulted. The next day, she underwent colonoscopy to decompress the colon. Post-procedure, laxatives begun the day before were continued and Relistor was added. Because of no apparent effect, on the next day she was given a 1000 mL golytely enema. On the following day, this was successful in resolving her obstipation. This was the seventh day of admission. Her symptoms and distension gradually improved and 4 days later KUB revealed a significant decrease in colonic dilation. She was discharged to a SNF the following day.

Conclusion:
Ogilvie syndrome is an important condition not to be missed--especially in the postoperative patients. Because its initial symptoms can be mild and because many of these patients may be too ill to report symptoms, this diagnosis may not be suspected until severe colonic dilation has occurred. Further, untreated or treated too late, Ogilive syndrome can be complicated by bowel infarction, perforation, peritonitis, and sepsis. In this case, frequent postoperative examination picked up subtle early abdominal distension that led to appropriate imaging which ultimately led to prompt diagnosis and effective treatment.