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Discipline

: Medicine

Sub Discipline

: Medicine

Document Title

: Medicine Procedure Note Oesophagus Gastro Duodenoscopy (OGDS)/ Upper GI Endoscopy

PROCEDURE DETAILS

Procedure Ordered

Procedure Requested By

Date & Time Of Procedure

From

To

Type Of Ogds

Location

PRE-SCOPE HISTORY

Previous Ogds

YesNoneNot known

Findings

Concomitant Medical Conditions

YesNoneNot known

Bronchial Asthma

COAD

Ischemic Heart Disease (IHD)

Hypertension

Diabetes

Vulvular Heart Disease

Prosthetic Cardiac Valve

Immunocompromised

Others, specify

Risk Factors

YesNoneNot known

AntiHCV

Current Medication

YesNoneNot known

Antibiotics

Comments

PERFORMING STAFF

Performing Staff

Indication[S]

Please Update Method

MEDICATION ADMINISTERED

Premedication

YesNo

Type

Topical Anaesthetic Spray

XylocaineLignocaine

Babcon/Simethicone Liquid

Sedation

YesNo

Smooth Muscle Relaxant

YesNo

Comments

GA

YesNo

Intubated

Comments

Antidote/ Reversal

YesNone

Comments

Antibiotic Prophylaxis

YesNo

Comments

PROCEDURE REPORT

[+] Oesophagus

Location Of Z-Line [Cm]

General Appearance

AbnormalNormal

[+] Stomach

General Appearance

AbnormalNormal

Gastritis

Site

Antrum

Contents

Empty

Clear fluid

Bile stained

Blood

Food debris

Foreign Body

Helminths

Others

[+] Duodenum

General Appearance

AbnormalNormal

Ulcer

Site

Bulbar

[+] Procedure

Biopsy

Site Of Biopsy

Ampulla

DIAGNOSIS

Endoscopic Impression

Post-Procedure Instructions

Follow-Up Plan

SIGNATURES

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