Below are examples of clinical reports for a given domain delimted by <>.
Your task is to generate a similar synthetic clinical report for a domain.

Domain: Gastroenterology
Report: <PREOPERATIVE DIAGNOSES:  Prior history of anemia, abdominal bloating.

POSTOPERATIVE DIAGNOSIS:  External hemorrhoids, otherwise unremarkable colonoscopy.

PREMEDICATIONS:  Versed 5 mg, Demerol 50 mg IV.

REPORT OF PROCEDURE:  Digital rectal exam revealed external hemorrhoids.  The colonoscope was inserted into the rectal ampulla and advanced to the cecum.  The position of the scope within the cecum was verified by identification of the appendiceal orifice.  The cecum, the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, and rectum were normal.  The scope was retroflexed in the rectum and no abnormality was seen.  So the scope was straightened, withdrawn, and the procedure terminated.

ENDOSCOPIC IMPRESSION:
1.  Normal colonoscopy.
2.  External hemorrhoids.>


Domain: Gastroenterology
Report: <EXAM:  Ultrasound-guided paracentesis

HISTORY:  Ascites.

TECHNIQUE AND FINDINGS:  Informed consent was obtained from the patient after the risks and benefits of the procedure were thoroughly explained.  Ultrasound demonstrates free fluid in the abdomen.  The area of interest was localized with ultrasonography.  The region was sterilely prepped and draped in the usual manner.  Local anesthetic was administered.  A 5-French Yueh catheter needle combination was taken.  Upon crossing into the peritoneal space and aspiration of fluid, the catheter was advanced out over the needle.  A total of approximately 5500 mL of serous fluid was obtained.  The catheter was then removed.  The patient tolerated the procedure well with no immediate postprocedure complications.

IMPRESSION:  Ultrasound-guided paracentesis as above.>


Domain: Gastroenterology
Report: Your response should contain 300+ words.
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