of 15 /15
Chapter XI K00-K93 Digestive System นพ.บก เจญล กมงานลยกรรม รพ.สวรรประชาก นครสวรร 1 Disease of Stomach 2 Dyspepsia Chronic or recurrent pain or discomfort centered in the upper abdomen when eating One or more the following symptoms (ROME III) Postprandial fullness Early satiety Epigastric pain Epigastric burning Functional dyspepsia [Non-ulcer dyspepsia] Peptic ulcer disease Gastroesophageal reflux disease dys “bad” or “difficult” & pepsis “digestion” = indigestion 3 Dyspepsia Subjective Diagnosis 4

Chapter XI K00-K93 Digestive System Disease of Stomach · Chapter XI K00-K93 Digestive System นพ.บิัก์ เจิญิล์ ก่มงานัลยกรรม

  • Author
    others

  • View
    2

  • Download
    0

Embed Size (px)

Text of Chapter XI K00-K93 Digestive System Disease of Stomach · Chapter XI K00-K93 Digestive System...

  • Chapter XI K00-K93 Digestive System

    นพ.บิัก์ เจิญิล์ ก่มงานัลยกรรม รพ.สวรร์ประชาัก์ นครสวรร์

    1

    Disease of Stomach

    2

    Dyspepsia

    Chronic or recurrent pain or discomfort centered in the upper

    abdomen when eating

    One or more the following symptoms (ROME III)

    Postprandial fullness

    Early satiety

    Epigastric pain

    Epigastric burning

    Functional dyspepsia [Non-ulcer dyspepsia]

    Peptic ulcer disease

    Gastroesophageal reflux disease

    dys “bad” or “difficult” & pepsis “digestion” = indigestion

    3

    Dyspepsia

    Summary Diagnosis ICD-10

    Dyspepsia

    Heartburn

    Indigestion

    Regurgitation

    Functional dyspepsia

    K30

    R12

    R11

    R11

    F45.3

    Subjective Diagnosis

    4

  • Gastritis

    Diagnosis view

    : Endoscopic diagnosis

    : Pathologic diagnosis

    : with underlying condition

    CAG

    CSG

    AEGAHG

    Objective Diagnosis

    5

    Gastritis

    Acute gastritis

    - Acute infectious gastritis: including H.pylori

    - Acute erosive gastritis: NSAID, alcohol, chemical ingestion

    - Acute hemorrhagic gastritis: ischemia

    Chronic gastritis

    - Helicobactor pylori type

    - Chronic atrophic gastritis: type A, type B

    - Chemical: bile reflux, NSAID

    - Granulomatous gastritis: Crohn’s disease, sarcoidosis, vasculitides

    - Allergic gastritis: Eosinophilic gastritis

    - Specific infection: HIV, TB, syphilis, cytomegalovirus, histoplasmosis

    Objective Diagnosis

    6

    Gastritis

    Summary Diagnosis ICD-10

    Acute erosive gastritis

    Acute hemorrhagic gastritis

    K29.0

    K29.0

    Alcoholic gastritis

    Allergic gastritis

    Giant hypertrophic gastritis [Menetrier’s disease]

    Granulomatous gastritis

    K29.2

    K29.6

    K29.6

    K29.6

    Eosinophilc gastritis

    Lymphocytic gastritis

    K52.8

    K29.6

    Gastritis K29.7

    Objective Diagnosis

    7

    Gastritis

    Summary Diagnosis ICD-10

    Chronic gastritis

    Chronic atrophic gastritis

    Chronic superficial gastritis

    Intestinal metaplasia

    K29.5

    K29.4

    K29.3

    K29.5

    Curling ulcer

    Cushing ulcer

    K25.0

    K25.0

    Viral gastritis

    Tuberculous gastritis

    Helicobacter pylori gastritis

    A08.4

    A18.8 + K93.8

    K29.- + B96.8

    Objective Diagnosis

    8

  • Peptic Ulcer

    An ulcer is defined as disruption of the mucosal integrity in a

    region that touches gastric acid and pepsin, so ‘peptic ulcer’

    refers to an ulcer in the lower esophagus, stomach or

    duodenum, in jejunum after surgical anastomosis to stomach or

    rarely in there ileum adjacent to Meckel’s diverticulum leading to

    local defect or excavation due to active inflammation.

    Acute: associated with superficial erosion and minimal

    inflammation

    Chronic: one of long duration eroding through the muscular

    wall with the formation of fibrous tissue

    9

    Peptic Ulcer

    acute chronic

    10

    Peptic Ulcer

    Gastric ulcer

    Duodenal ulcer

    Gastrojejunal ulcer / Marginal ulcer / Stomal ulcer

    Jejunal ulcer

    Dyspepsia

    !

    : Gastrointestinal ulcer ้องิิจัยจากการตรวจิเศษเ่า้น : Peptic ulcer ไ่ี่ใ้ในการิิจัยโรคในัจุัน : Dyspepsia ใ้ิิจัยจากอาการ [แทน peptic ulcer]

    11

    Peptic Ulcer

    Gastric ulcer

    Duodenal ulcer

    Gastrojejunal ulcer / Marginal ulcer / Stomal ulcer

    Jejunal ulcer

    Dyspepsia

    12

  • Gastric Ulcer

    Summary Diagnosis ICD-10

    Gastric ulcer K25.9

    Acute gastric ulcer

    Acute gastric ulcer with bleeding

    Acute gastric ulcer with perforation

    Acute gastric ulcer with bleeding and perforation

    K25.3

    K25.0

    K25.1

    K25.2

    Chronic gastric ulcer

    Chronic gastric ulcer with bleeding

    Chronic gastric ulcer with perforation

    Chronic gastric ulcer with bleeding and perforation

    K25.7

    K25.4*

    K25.5*

    K25.6*

    * included Unspecified Gastric Ulcer

    13

    Duodenal Ulcer

    Summary Diagnosis ICD-10

    Duodenal ulcer K26.9

    Acute duodenal ulcer

    Acute duodenal ulcer with bleeding

    Acute duodenal ulcer with perforation

    Acute duodenal ulcer with bleeding and perforation

    K26.3

    K26.0

    K26.1

    K26.2

    Chronic duodenal ulcer

    Chronic duodenal ulcer with bleeding

    Chronic duodenal ulcer with perforation

    Chronic duodenal ulcer with bleeding and perforation

    K26.7

    K26.4*

    K26.5*

    K26.6*

    * included Unspecified Duodenal Ulcer

    14

    Barry J Marshall & J Robin Warren at Perth, first discover

    in the stomachs of gastritis and gastric ulcer at 1982

    Diagnosis of H.pylori infection

    Non-endoscopic tests

    : Blood antibody

    : Urea breath test

    : Stool antigen

    Endoscopic tests

    : Biopsy urease test “CLO-test”

    : Histology

    : Culture

    Helicobacter pyloriB98.0 H.pylori infection

    15

    Helicobacter pylori diseases classified to other chapters

    B98.0 Helicobacter pylori [H.pylori] as the cause of diseases classified

    to other chapters-B98.1 Vibrio vulnificus as the cause of diseases classified to other

    -

    16

  • Gastrointestinal Bleeding

    Hematemesis

    อาเียนเ็นเือดแดงสด หือเือดีำเ่าๆ [coffee-ground] Hematochezia

    ่ายเ็นเือดีแดงสด Melena

    ุจจาระีีำเ็นัน เหียว และีก่นเห็น [เือดออก 60 ิลิิตร] Stool occult blood

    Rectal bleeding

    17

    Gastrointestinal Bleeding

    Summary Diagnosis ICD-10 Neonate

    Hematemesis

    Hematochezia

    Melena

    Stool occult blood

    Upper gastrointestinal bleeding

    Coffee ground [NG lavage]

    Coffee ground emesis

    Lower gastrointestinal bleeding

    Gastrointestinal bleeding

    Rectal bleeding

    K92.0

    K92.1

    K92.1

    R19.5

    K92.2

    K92.2

    K92.0

    K92.2

    K92.2

    K62.5

    P54.0

    P54.1

    P54.1

    -

    P54.3

    P54.3

    P54.0

    P54.3

    P54.3

    P54.2

    18

    Gastrointestinal Bleeding

    กรีตรวจพบรอยโรค เ่น erosion, ulcer, varix สามารถิิจัย่าเ็นสาเหุของเือดออกไ้ โดยไ่ำเ็น้อง พบ่าเือดออกในขณะ้น (acute bleeding) แพท์ควรระุ่า lesion with bleeding หือ hemorrhage ้ใ้รัส้องตรวจสอบรัสการิิจัย่า ำเ็น้องเ่มรัส

    ของ gastrointestinal bleeding เ่มเิมหือไ่ [บางรัสการ

    ิิจัยไ้ครอบคุม้วย เ่น K72.6 Mallory-Weiss tear]

    19

    FORREST classification

    Clinical Diagnosis Endoscopic Finding

    Acute bleeding

    Forrest Ia

    Forrest Ia

    !

    Arterial spurting bleeding

    Oozing bleeding

    Recent bleeding

    Forrest IIa

    Forrest IIb

    Forrest IIc

    !

    Ulcer with non-bleeding visible vessel

    Ulcer with adherent clot on surface

    Ulcer with hematin-covered lesion

    Lesions without active bleeding

    Forrest III

    !

    Ulcer with clean base

    20

  • Endoscopic Findings

    21

    Peptic Ulcer Coding

    The following fourth-character subdivisions are for use with categories

    K25-K28:

    .0 Acute with haemorrhage

    .1 Acute with perforation

    .2 Acute with both haemorrhage and perforation

    .3 Acute without haemorrhage or perforation

    .4 Chronic or unspecified with haemorrhage

    .5 Chronic or unspecified with perforation

    .6 Chronic or unspecified with both haemorrhage and perforation

    .7 Chronic without haemorrhage or perforation

    .9 Unspecified as acute or chronic, without haemorrhage or

    perforation

    K25 Gastric ulcer

    22

    - Endoscopic injection therapy: saline, adrenaline

    - Endoscopic clipping

    - Endoscopic coagulation: heater probe, gold probe, APC

    44.43 Endoscopic control gastric and duodenal bleeding

    Endoscopic Stop Bleeding

    23

    Peptic Ulcer Perforation

    24

  • 44.41 Simple closure of gastric ulcer perforation

    44.42 Simple closure of duodenal ulcer perforation

    !

    ไ่้องใ้รัสัตถการ Omental graft, Peritoneal toilet !

    !

    !

    Peptic Ulcer Perforation

    25

    Peptic Ulcer Obstruction

    ิิจัยจากอาการ [pyloric obstruction] : Splashing sound

    ิิจัยจากการตรวจเ่มเิม [pyloric or duodenal obstruction] : สามารถระุสาเหุของภาวะ้ ใ้ันึกสาเหุเ็นการิิจัยหัก : ไ่สามารถระุสาเหุของภาวะ้ ใ้ันึกำแห่งุ่ดันเ็นการิิจัยหัก

    ‘Gastric Outlet Obstruction’

    26

    Gastric Outlet Obstruction

    27

    Gastric Outlet Obstruction

    Summary Diagnosis ICD-10

    Pyloric obstruction

    Duodenal obstruction

    K31.1

    K31.5 Acute distension of stomach

    K31.1 Adult hypertrophic pyloric stenosis

    Pyloric stenosis NOS

    Excludes: congenital or infantile pyloric stenosis ( Q40.0 )

    K31.2 Hourglass stricture and stenosis of stomach

    Excludes: congenital hourglass stomach ( Q40.2 )

    hourglass contraction of stomach ( K31.8 )

    K31.3 Pylorospasm, not elsewhere classified xcludes: pylorospasm:

    xcludes: congenital diverticulum of stomach ( Q40.2 )

    K31.5 Obstruction of duodenum

    Constriction

    Stenosis

    Stricture } of duodenum

    Duodenal ileus (chronic)

    Excludes: congenital stenosis of duodenum ( Q41.0 )

    K31.6 Fistula of stomach and duodenum

    clinical diagnosis ‘unknown etiology'

    28

  • Esophageal Varices

    29

    Bleeding Esophageal Varices

    เกณ์การิิจัย สปสช.2559 : ีประัิอาเียนเ็นเือดหือ่ายำ

    : ีการันึกิิจัยของแพท์ Bleeding esophageal varices - พบ active bleeding - ไ่พบ recent/active bleeding หือ - ีเือดออก้ภายใน 10 ันหังำห่าย - ้องีการักษาโรค้ [SB-tube, Somatostatin, Vasopressin]

    กรีทราบสาเหุ ้องันึกเ็นโรคหัก ใ้รัส I98.2* หือ I98.3*

    30

    Esophageal Varices

    Summary Diagnosis ICD-10

    Bleeding esophageal varices

    Bleeding esophageal varices due to cirrhosis

    Bleeding esophageal varices due to alcoholic cirrhosis

    Bleeding esophageal varices due to hepatitis cirrhosis

    I85.0

    K74.6 + I98.3

    K70.3 + I98.3

    B15-B19 + I98.3

    Esophageal varices I85.9· lesions of pinta [carate] ( A67.2† )

    I98.2* Oesophageal varices without bleeding in diseases classified

    elsewhere

    Oesophageal varices in:

    · liver disorders ( K70-K71† , K74.-† )

    · schistosomiasis ( B65.-† )

    I98.3* Oesophageal varices with bleeding in diseases classified

    elsewhere- Oesophageal varices in:

    · liver disorders ( K70-K71† , K74.-† )

    · schistosomiasis ( B65.-† )

    I98.8* Other specified disorders of circulatory system in diseases

    classified elsewhere

    31

    Disease of Appendix

    32

  • Appendicitis

    Abscess of appendix

    K35.2 Acute appendicitis with generalized peritonitis- Appendicitis (acute) with generalized (diffuse) peritonitis

    following rupture or perforation

    K35.3 Acute appendicitis with localized peritonitis- Acute appendicitis with localized peritonitis with or without

    rupture or perforation

    Acute appendicitis with peritoneal abscess

    K35.8 Acute appendicitis, other and unspecified- Acute appendicitis without mention of localized or generalized

    peritonitis

    K35.9 Acute appendicitis, unspecified

    Acute appendicitis with peritonitis, localized or NOS

    33

    Appendicitis

    กรีีการ่าัดไ้่ง Acute appendicitis with localized peritonitis

    : ตรวจพบ rebound tenderness/guarding ่้อง้อยขวา : ไ่่าจะเ็น ruptured/accidental ruptured Acute appendicitis with generalized peritonitis

    : ตรวจพบ rebound tenderness/guarding ้งสอง่ง : ักเ็น ruptured ่วมับหนองกระจาย่ว้ง่อง้อง

    กรีไ่ีการ่าัดไ้่ง สถานภาพำห่าย ้องไ่ใ่ improved-approval ยกเ้น ีหักฐานืนันการิิจัย หือ ี้อ้าม่อการ่าัด

    34

    Appendicitis

    กรีีการ่าัดไ้่ง Acute appendicitis with localized peritonitis

    : ตรวจพบ rebound tenderness/guarding ่้อง้อยขวา : ไ่่าจะเ็น ruptured/accidental ruptured Acute appendicitis with generalized peritonitis

    : ตรวจพบ rebound tenderness/guarding ้งสอง่ง : ักเ็น ruptured ่วมับหนองกระจาย่ว้ง่อง้อง

    กรีไ่ีการ่าัดไ้่ง สถานภาพำห่าย ้องไ่ใ่ improved-approval ยกเ้น ีหักฐานืนันการิิจัย หือ ี้อ้าม่อการ่าัด

    35

    Appendicitis

    Summary Diagnosis ICD-10

    Appendicitis

    Acute appendicitis

    Acute appendicitis with localized peritonitis

    Acute inflammatory appendicitis

    Appendiceal abscess

    K37

    K35.8

    K35.3

    !

    !

    !

    !

    K35.3

    Ruptured appendicitis with generalized peritonitis

    Peritonitis due to ruptured peritonitis

    K35.2

    K35.2

    Chronic appendicitis K36

    Acute suppurative appendicitis

    Acute gangrenous appendicitis

    Ruptured appendicitis

    36

  • Appendectomy

    QRGTCVKQPU"QP"VJG"FKIGUVKXG"U[UVGO"*64/76+

    - New code ""® Revised code fl 4th digit re

    -

    Gzenwfgu

  • Hernia

    41

    Groin Hernia

    Indirect inguinal hernia (IIH)

    Direct inguinal hernia (DIH)

    Femoral hernia (FH)

    ภาวะแทรก้อน : Incarcerated hernia เ็นไ้เ่อน่ไ่สามารถัน่วน่ไหลออก มากับเ้าไปใน่อง้อง : Strangulated hernia เ็นไ้เ่อน่ำใ้ีการขาดเือดไปเ้ยง ของ่วน่ไหลออกมาและเิดเ่า (gangrene) ตามมาไ้ : Bowel obstruction เ็นไ้เ่อน่ำใ้ีการุดันของำไ้

    Strangulation…..IS…..Gangrene…..in Practice

    42

    K40 Inguinal hernia Includes: bubonocele

    inguinal hernia:

    · NOS

    · direct

    · double

    · indirect

    · oblique

    scrotal hernia

    K40.0 Bilateral inguinal hernia, with obstruction, without gangrene

    K40.1 Bilateral inguinal hernia, with gangrene

    K40.2 Bilateral inguinal hernia, without obstruction or gangrene Bilateral inguinal hernia NOS K40.3 Unilateral or unspecified inguinal hernia, with obstruction,

    without gangrene

    Inguinal hernia (unilateral):

    · causing obstruction

    · incarcerated

    · irreducible

    · strangulated

    without gangrene

    K40.4 Unilateral or unspecified inguinal hernia, with gangrene

    Inguinal hernia NOS with gangrene

    K40.9 Unilateral or unspecified inguinal hernia, without obstruction

    or gangrene

    Inguinal hernia (unilateral) NOS

    K41 Femoral hernia

    Groin Hernia

    43

    Groin Hernia

    Inguinal hernia (unilateral) NOS

    K41 Femoral hernia K41.0 Bilateral femoral hernia, with obstruction, without gangrene

    K41.1 Bilateral femoral hernia, with gangrene

    K41.2 Bilateral femoral hernia, without obstruction or gangrene

    Bilateral femoral hernia NOS

    K41.3 Unilateral or unspecified femoral hernia, with obstruction,

    without gangrene

    Femoral hernia (unilateral):

    · causing obstruction

    · incarcerated

    · irreducible

    · strangulated

    without gangrene

    K41.4 Unilateral or unspecified femoral hernia, with gangrene

    K41.9 Unilateral or unspecified femoral hernia, without

    obstruction or gangrene

    Femoral hernia (unilateral) NOS

    K42 Umbilical hernia

    Strangulation…..IS…..Gangrene…..in Practice

    Strangulation…..NOT…..Gangrene…..in ICD-10

    44

  • Groin Hernia

    Clinical Diagnosis ICD-10 Diagnosis

    Hernia

    Reducible hernia

    Sliding hernia

    Pantaloon hernia

    Recurrent hernia

    Hernia

    Incarcerated hernia

    Irreducible hernia

    Hernia with obstruction

    Obstructed hernia Hernia with obstruction

    Strangulated hernia Hernia with obstruction

    Hernia with gangrene Hernia with gangrene

    Hernia with obstruction with gangrene

    45

    Groin Hernia

    Summary DiagnosisICD-10

    Unilateral Bilateral

    Inguinal hernia

    Indirect inguinal hernia

    Direct inguinal henia

    Femoral hernia

    Hernia

    K40.9

    K40.9

    K40.9

    K41.9

    K46.9

    K40.2

    K40.2

    K40.2

    K41.2

    K46.9

    Incarcerated inguinal hernia

    Obstructed inguinal henia

    Incarcerated femoral hernia

    Obstructed femoral hernia

    K40.3

    K40.3

    K41.3

    K41.3

    K40.0

    K40.0

    K41.0

    K41.0

    46

    Groin Hernia

    Summary DiagnosisICD-10

    Unilateral Bilateral

    Incarcerated indirect inguinal hernia

    Incarcerated direct inguinal hernia

    Obstructed indirect inguinal henia

    Obstructed direct inguinal hernia

    Incarcerated femoral hernia

    Obstructed femoral hernia

    K40.3

    K40.3

    K40.3

    K40.3

    K41.3

    K41.3

    K40.0

    K40.0

    K40.0

    K40.0

    K41.0

    K41.0

    47

    Groin Hernia

    Summary DiagnosisICD-10

    Unilateral Bilateral

    Strangulated indirect inguinal hernia

    Strangulated direct inguinal hernia

    Strangulated femoral hernia

    K40.3

    K40.3

    K41.3

    K40.0

    K40.0

    K41.0

    Indirect inguinal hernia with gangrene

    Direct inguinal hernia with gangrene

    Femoral hernia with gangrene

    K40.4

    K40.4

    K41.4

    K40.1

    K40.1

    K41.1

    Strangulation…..NOT…..Gangrene…..in ICD-10

    48

  • Repair of Hernia

    Herniotomy and Herniorrhaphy or Hernioplasty

    Non-mesh repair vs Mesh repair

    Open repair vs Laparoscopic repair

    49

    Repair of Hernia

    Open and Non-mesh repair

    : Herniotomy

    : Bassini herniorrhaphy

    : McVay herniorrhaphy

    : Shouldice herniorrhaphy

    : Halsted herniorrhaphy

    : Furguson herniorrphaphy

    50

    Repair of Hernia

    Open and Mesh repair

    : Lichtenstein hernioplasty

    : Plug and patch hernioplasty

    51

    Repair of Hernia

    Laparoscopic repair [all mesh repair]

    - Total extraperitoneal technique (TEP)

    - Transabdominal preperitoneal approach (TAPP)

    TEP

    TAPP

    TAPP

    52

  • Repair of Groin Hernia

    KEF/;/EO"VCDWNCT"NKUV"QH"RTQEGFWTGU"*H[32+"

    Gzenwfgu

  • Groin Hernia

    Summary ProcedureICD-9-CM

    Unilateral Bilateral

    Hernioplasty 53.05 53.17

    Indirect hernioplasty

    Direct hernioplasty

    Femoral hernoplasty

    53.04

    53.03

    53.21

    53.15

    53.14

    53.31

    Indirect herniorrhaphy with mesh graft

    Direct herniorrhaphy with mesh graft

    Femoral herniorrhaphy with mesh graft

    53.04

    53.03

    53.21

    53.15

    53.14

    53.31

    Lichtenstein hernioplasty

    Plug and patch hernioplasty

    ?

    ?

    ?

    ?

    57

    Groin Hernia

    Summary ProcedureICD-9-CM

    Unilateral Bilateral

    Laparoscopic hernioplasty 17.13 17.24

    Laparoscopic indirect hernioplasty

    Laparoscopic direct hernioplasty

    17.12

    17.11

    17.22

    17.21

    58