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Hiatal Hernias

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Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia.
The hiatus is an opening in the diaphragm — the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.
There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.
The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become “strangled,” or have its blood supply shut off.
Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

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Emergency & Critical Care Medicine

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Emergency medicine, also known as accident and emergency medicine, is the medical specialtyconcerned with caring for undifferentiated, unscheduled patients with illnesses or injuries requiring immediate medical attention. In their role as first-line providers, emergency physicians are responsible for initiating resuscitation and stabilization, starting investigations and interventions to diagnose and treat illnesses in the acute phase, coordinating care with specialists, and determining disposition regarding patients’ need for hospital admission, observation, or discharge. Emergency physicians generally practice in hospital emergency departments

Critical care: The specialized care of patients whose conditions are life-threatening and who require comprehensive care and constant monitoring.

 

Matthew Johnson is a Fellowship Trained Trauma, Emergency & Critical Care physician.

 

What Is General Surgery?

What Is General Surgery?

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General surgeons care for a wide range of conditions, from cancer to obesity. General surgery is a surgical specialty that focuses on the complex and interrelated organs in the abdomen. These include:

  • Esophagus
  • Stomach
  • Small bowel
  • Colon
  • Liver
  • Pancreas
  • Gallbladder
  • Bile ducts

General Surgery Procedures

You may have many questions about your surgical procedure. How will my doctor decide whether I need surgery? Will I need to stay overnight in the hospital? What type of anesthesia will the surgeon use?

Dr Matthew Johnson and the entire staff at Desert Surgical Associates  are available to answer your questions.

MATTHEW JOHNSON, MD Trauma Surgeon, General Surgeon & Critical Care Surgeon

Dr Johnson newsletter-bioMATTHEW JOHNSON, MD Trauma Surgeon, General Surgeon &
Critical Care Surgeon
Dr. Matthew Johnson is a very compassionate surgeon that always takes extra time when communicating with his patients as well as their families regarding their care. He is driven, kind, and extremely innovative in the field of surgery. He is also one of the few surgical endoscopists in the country. In 2011, as a chief resident, he received the Professionalism Award at the University of Nevada School of Medicine and continues to emphasize this professionalism throughout his surgical practice. He is very well respected by his colleagues in the field and always strives for perfection.

Dr. Johnson did his undergraduate training at the University of Texas at Austin and is a faithful Texas Longhorn to this day. He subsequently attained his Medical Doctorate at the American University of the Caribbean, in St. Maarten, N.A. where he also attained a Masters in Medical Science (M.M.S.). Dr. Johnson’s residency training was completed at the University of Nevada School of Medicine, Las Vegas, NV in General Surgery (2005-11).

He then went on to become one of the early fellows in the country to complete an Acute Care Surgery fellowship at the University of Nevada School of Medicine, Las Vegas, NV (2011-13). During his residency and fellowship, Dr. Johnson also trained in Surgical Endoscopy with a specific emphasis on both diagnostic & therapeutic ERCP. In fact, along with other colleagues, he developed a new method for treating obstructing complicated biliary disease using combined cholecystectomy and ERCP in a one stage procedure, so-called the “One-Step/ELBS”. Throughout residency and fellowship, Dr. Johnson presented at many national conferences regarding ERCP use by surgeons for trauma and general surgery in addition to authoring several publications.
Following post-graduate training, Dr. Johnson joined Desert Surgical Associates and hit the ground running. He cares for patients in the field of general surgery, minimally invasive surgery, trauma, and critical care. Dr. Johnson’s specific interests involve minimally invasive robotic surgery, advancement of minimally invasive surgery in trauma patients, foregut surgery, hepatobiliary surgery and the use of ERCP for both diagnostic and therapeutic measures.

 

Benefits of Robotic Surgery

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Robotic surgery offers many benefits to patients compared to open surgery, including:
Shorter hospitalization.
Reduced pain and discomfort.
Faster recovery time and return to normal activities.
Smaller incisions, resulting in reduced risk of infection.
Reduced blood loss and transfusions.
Minimal scarring.
For your consultation:
Call Matt Johnson, MD
Desert Surgical Associates  Phone: 702.369.7152

ROBOTIC SURGERY: Generates Successful Outcomes

robotic surgeryMedical historians disagree on which was the first robot for medical use and when the first robot-assisted surgery took place. Some say the first was the “Arthrobot”, which was developed and used for the first time in Vancouver, BC, Canada in 1983. Others say the first documented use of a robot to assist with a surgical procedure occurred in 1985 when the PUMA 560 was used with CT scan to place a needle for a neurosurgical biopsy.  They can agree on one thing about its history, though; the robotic system offered greater precision and successful outcomes. This led to the first robot-assisted laparoscopic procedure in 1987.

Experts continued to improve on these surgery-enhancing robotic machines over the next 20 years, and in 2000, the da Vinci robot became the first complete robotic surgical system to be approved by the FDA for general laparoscopic surgery.  Since then, the list of procedures performed laparoscopically with robot assistance has grown at a pace consistent with improvements in technology and the technical skill of surgeons. Now daVinci is used frequently around the world for performing bariatric and gastrointestinal surgery, cardiothoracic surgery, ear, nose and throat surgery, gynecological surgery, and even pediatric surgery, among others.

Surgeons, patients, and insurance companies agree that minimally invasive, robot-assisted surgery offers great benefits over traditional open surgery. Incisions are smaller, so procedures leave little to no scars. The risk of infection is less, hospital stays are shorter, if necessary at all, and convalescence is significantly reduced. Many studies have shown that laparoscopic procedures result in decreased hospital stays, a quicker return to the workforce, decreased pain, and better postoperative immune function.

If you think you might be a candidate for robotic surgery, schedule a consultation with Dr. Johnson, a Las Vegas board-certified robotic surgeon.

Do You Have Nighttime ACID REFLUX Symptoms?

 

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Nighttime heartburn may be particularly dangerous. Waking up with a sour taste in the mouth, coughing, or sore throat may indicate nighttime acid reflux. Not only does it disturb sleep, but the esophagus may sustain more damage. That’s because when you are lying down for several hours, acid has a lot of time to linger in the esophagus and damage the tissue. When we are awake, we swallow saliva throughout the day. Saliva helps neutralize stomach acid. We naturally swallow less saliva when we sleep, so stomach acid is not neutralized.

Gastroesophageal reflux disease: GERD,

downloadGastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Doctors believe that some people suffer from GERD due to a condition called hiatal hernia. In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.

  • Common signs and symptoms of GERD include:
    A burning sensation in your chest (heartburn), usually after eating, which might be worse at night.
    Chest pain.
    Difficulty swallowing.
    Regurgitation of food or sour liquid.
    Sensation of a lump in your throat.

Popular over-the-counter medications like Tums, Maalox, Rolaids and Mylanta neutralize stomach acid and provide fast-acting relief in mild or isolated cases of acid reflux. Some antacids come in liquid form to coat the lining of the esophagus and help reduce the amount of acid in the stomach.

If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis, esophageal ulcers, bleeding, or scarring of the esophagus. Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment of GERD when medicines are not successful.

APPENDICITIS: SYMPTOMS AND TREATMENT

APPENDICITIS: SYMPTOMS AND TREATMENT

appendicitisComplaints of a pain in the side will almost always bring the suggestion, “Maybe it’s appendicitis!” It’s true that pain is one of the symptoms, but what is appendicitis, and how do you know if you really might be having an attack? If you are suffering from appendicitis, what is the treatment?

Let’s start by looking at what the organ known as the appendix does. The human appendix is a finger-shaped pouch that projects from the colon on the lower right side of the abdomen. Previously thought to have no redeeming functions, new research shows that the appendix seems to play a part in immune functions and digestion, and it is especially important during fetal development through the third decade of life.

When this small organ becomes inflamed and filled with pus, it is called appendicitis. This is thought to be caused by infection that finds its way into the organ or perhaps from a blockage containing bacteria that causes infection.

Regardless of the cause, appendicitis usually presents itself as pain near the navel, moving to the lower right side and becoming severe. The pain is often made worse by coughing or other body-jarring movements. Sometimes accompanied by nausea and vomiting, fever, loss of appetite, constipation or diarrhea, and abdominal bloating, appendicitis can be quite painful and serious.  If not treated promptly, the appendix can even rupture, leading to serious issues.

Typically, surgery to remove the appendix (appendectomy) along with antibiotics for infection is the preferred treatment for appendicitis. Appendectomy can be performed as open surgery requiring a relatively large incision or laparoscopically with a few very small abdominal incisions. In general, laparoscopic surgery takes less recovery time with less pain and scarring, but each case is unique.

Schedule an appointment with Dr. Johnson to discuss surgical options.

ACUTE CARE SURGERY

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As medicine changes and modernizes, new specialties arise. General surgery is seeing new fields emerge. One is acute care surgery. Acute care surgery is an evolving specialty with three essential components – trauma, critical care, and emergency surgery.  Acute care surgeons provide multidisciplinary care for patients who require emergency surgery because of an accident or sudden illness. This care continues throughout the patient’s hospitalization and following discharge.

These changes in surgery are in response to a number of forces. General surgeons are becoming increasingly more focused, especially in areas such as advanced laparoscopic surgery, bariatric (obesity) surgery, endovascular surgery, and breast surgery. With these areas of concentration, come less interest in being on call for emergencies (especially during “off” hours), which can interfere with other, non-emergency cases and office practice. In addition, many trauma surgeons wish to increase their operative case load because trauma care itself has become less involved with operative procedures.

As this specialty has grown, acute surgical emergencies often represent the most common reason for hospital admission. These conditions include, but are not limited to: acute appendicitis, cholecystitis or gallbladder disease, diverticulitis, pancreatitis, intestinal obstruction, intestinal ischemia, intra-abdominal sepsis, incarcerated hernias and perforated viscous.

Acute care surgery integrates the long-established field of trauma surgery with the management of general surgical emergencies. Traditionally, management of non-traumatic emergency conditions requiring surgery has been entrusted to both general surgeons and surgical subspecialists, depending on the supply and availability of these surgeons in each hospital, but as stated above, many surgeons are reluctant to take on-call responsibilities.

Dr. Matthew Johnson is board-certified in acute care surgery, general surgery, and critical care, as well as being a board-certified robotic surgeon. After completing his residency in general surgery, he then went on to become one of the early fellows in the country to complete an acute care surgery fellowship at the University of Nevada School of Medicine.