Complicated surgical infections

Size: px
Start display at page:

Download "Complicated surgical infections"

Transcription

1 Complicated surgical infections JASLYN DOSHI ID ADVANCED TRAINEE, WESTMEAD

2 HOPC 46 F admitted 13 th March 2017 Epigastric pain Vomiting Diarrhoea

3 Background Gastric banding 2009 Vomiting since last year band found to have slipped from position Awaiting removal of band MVA 2009 # Pelvis has metalware in pelvis Depression Migraines Meds: Mersyndol PRN for headaches Agomelantine 50mg daily (melatonin analogue antidepressant)

4 Bloods

5 Imaging USS Abdo: Cholelithiasis, with features of chronic cholecystitis. Dilated extrahepatic biliary tree with debris/calculi in the lower CBD not excluded. There is intraperitoneal as well as retroperitoneal fluid, presumably a consequence of the pancreatitis. CT abdo Extensive intraperitoneal fluid - peripancreatic and retroperitoneal fluid.

6

7 Diagnosis Severe gallstone pancreatitis with SIRS response E coli bacteremia

8 Intra-abdominal collections Multiple CTs over the course of next few weeks showed multiple collections Peri-pancreatic Retroperitoneal Intraperitoneal Percutaneous drainage Ongoing fevers settled with drainage Recollection Tracheostomised

9 19/3 E coli in BC 11/4 to 1/5 E coli in repeated aspirates and drain fluids 19/3 MSSA in sputum 8/4 Acinetobact er in BAL 22/4 Stenotropho monas in sputum Tazocin Meropenem Cephazolin Tazocin Tazocin and Bactrim

10

11 Progress CT imaging Appearances of the upper abdominal retroperitoneal to extraperitoneal collections are little changed. There is a now a drain coursing through the right perinephric collection with minimal reduction in collection size. A second drain has been inserted into the left flank collection, also little changed in calibre. Persistent extraperitoneal collection extending into the left pararectal region is again noted. The liver, spleen, adrenals and kidneys appear normal. There is sludge layering within gallbladder. Pancreas appears slightly swollen and of heterogeneous density, particularly at the head and neck. Large quantity of gas associated with predominant retroperitoneal and extraperitoneal collections were again noted.

12 Aspirate culture 11/4 Aspirate culture 24/4 Drain fluid culture 22/4 Aspirate culture 24/4

13 Aspirate culture 1/5 Drain fluid culture 12/5 Aspirate culture 18/5 Drain fluid culture 25/5

14 19/3 E coli in BC 11/4 to 1/5 E coli, Kleb Pneumo, anerobes in repeated aspirates and drain fluids 12/5 Candida in drain fluid 25/5, 1/6 Pseudomonas aeruginosa (I to Mero) Stenotrophomonas maltophilia in drain fluid 19/6 E coli (S) in drain fluid 19/3 MSSA in sputum 8/4 Acinetobact er in BAL 22/4 Stenotropho monas in sputum 25/5, 27/5 Stenotrophomonas and Acinetobacter 23/6 Pseudomon as in sputum Tazocin Meropenem Cephazolin Tazocin Tazocin Meropenem, and Clindamycin Bactrim and metronidazole Tigecycline Meropenem Tigecycline Meropenem Anidulafungin 7/6 Abx ceased, Anidula continue d Screens MRSA pos ESBL E coli pos VRE pos

15

16

17 CONCLUSIONS In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities

18

19 So far Day 94 ICU Necrotising gallstone pancreatitis resulting in multiple intraabdominal collections requiring multiple drains Chronic infected pancreatic pseudocysts - having ongoing temperatures Slow ventilatory wean Deconditioning after long hospital stay 6 weeks of Cephazolin, Tazocin, Meropenem 4 weeks of Tigecycline - Started on 5/5 ~6 weeks of Meropenem -Started on 27/4 ~2 weeks of Anidulafungin- started on 22/5

20 Continues to drain pus Febrile and tachycardic

21 21/6 : Necrosectomy, subtotal cholecystectomy, removal of gastric band, washout of abdomen with 4 paracolic drains Cef/Metro Tazocin Faeculent material through drains -?uncontained intraabdominal contamination 4/7: Laparotomy, adhesiolysis, washout of multiple intraabdominal collections, right hemi-colectomy and formation of end ileostomy 6/7: Re-look laparotomy, removal of packs, washout of intra-abdominal abscess, repair of small bowel serosal tear

22 Few further surgeries in the following days Relook laparatomies Washouts Change of abdominal packing Insertion of biological mesh Abdominal closure with drains in situ continue to drain Abx ceased Temps and CRP rise

23 Ongoing collections Ciprofloxacin started Meropenem /Metronidazole Subdiaphrapgmatic fluid aspirated Mixed anaerobes including Bacteroides vulgatus Sputum Drain fluid

24 Bile leak in drain Presumed mesh infection Changed to Ceftazidime/Gent ERCP with sphincterotomy, insertion of stent and biliary drainage

25 Questions to ponder What are the primary pathogens? Yes of course.. source control How and why bacteria 'disappear' and then re-emerge in these situations Resistant organism always selected out on broad spectrum Abx treatment?delay in considering definitive therapy Who/when do we make this call Antibiotic holidays -?evidence E coli and superinfecting pathogens including varying resistant pseudomonas and other saprophytic opportunists in drains and ETT aspirates.

26 And on Selection of MRO Microbiological results do not always reflect what s really going on focus on 'real' pathogens - basis of selective reporting When to use what? Cell-wall active agents more useful vs intracellular drugs like aminoglycosides/ quinolones etc Tazocin, Stepped down to Augmentin DF

27 Progress Stepped down to ward ICU admission for 160 days! Frozen abdomen Antibiotics ceased Progress CT tiny remainder collections Drains still in situ Repeat ERCP stent removed

28 Lessons Source control Prolonged antibiotics and selection of MRO The role of antimicrobial stewardship vs regular ID input Better management if MDT approach taken?

GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT

GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT Name & Title Of Author: Dr Linda Jewes, Consultant Microbiologist Date Amended: December 2016 Approved by Committee/Group: Drugs & Therapeutics

More information

Disclosures. Extra-hepatic Biliary Disease and the Pancreas. Objectives. Pancreatitis 10/3/2018. No relevant financial disclosures to report

Disclosures. Extra-hepatic Biliary Disease and the Pancreas. Objectives. Pancreatitis 10/3/2018. No relevant financial disclosures to report Extra-hepatic Biliary Disease and the Pancreas Disclosures No relevant financial disclosures to report Jeffrey Coughenour MD FACS Clinical Associate Professor of Surgery and Emergency Medicine Division

More information

Bladder Trauma Data Collection Sheet

Bladder Trauma Data Collection Sheet Bladder Trauma Data Collection Sheet If there was no traumatic injury with PENETRATION of the bladder DO NOT proceed Date of injury: / / Time of injury: Date of hospital arrival: / / Time of hospital arrival:

More information

Intra-Abdominal Infection

Intra-Abdominal Infection Intra-Abdominal Infection Case presentation 4th Sept 2013 Done by : Noor Al-Hakami Pharm D Candidate, KSU Objectives: Intra-abdominal infection (overview) Case presentation Relevant Studies Introduction

More information

Hospital-acquired Pneumonia

Hospital-acquired Pneumonia Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired

More information

General'Surgery'Service'

General'Surgery'Service' General'Surgery'Service' Patient Care Goals and Objectives 1)! Stomach/Duodenum and Bariatric 2)! Interpret the results of clinical evaluations (history, physical examination) performed on patients being

More information

A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM

A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM *Sumanta Kumar Ghosh and Biswajit Mukherjee ESIC Medical College, Joka, Kolkata, India *Author for Correspondence ABSTRACT Occurrence

More information

Comprehensive Study of Acute Pancreatitis (Diagnosis, Disease Course, and Clinical Management): A Retrospective and Prospective Study

Comprehensive Study of Acute Pancreatitis (Diagnosis, Disease Course, and Clinical Management): A Retrospective and Prospective Study Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/449 Comprehensive Study of Acute Pancreatitis (Diagnosis, Disease Course, and Clinical Management): A Retrospective

More information

ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM

ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM DATA COLLECTION FORM Most Australian hospitals contribute data

More information

The Bile Duct (and Pancreas) and the Physician

The Bile Duct (and Pancreas) and the Physician The Bile Duct (and Pancreas) and the Physician Javaid Iqbal Consultant in Gastroenterology and Pancreato-biliary Medicine University Hospital South Manchester Not so common?! Two weeks 38 ERCP s 20 15

More information

JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES

JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES THE PROBLEM DUODENAL / PANCREATIC INJURIES Difficult to diagnose Not very common Anatomic and physiologic challenges 90% rate of associated

More information

MANAGEMENT OF PYOGENIC LIVER ABSCESS BOYOUNG SONG, M.D. SUNY DOWNSTATE SURGERY 11/7/13

MANAGEMENT OF PYOGENIC LIVER ABSCESS BOYOUNG SONG, M.D. SUNY DOWNSTATE SURGERY 11/7/13 MANAGEMENT OF PYOGENIC LIVER ABSCESS BOYOUNG SONG, M.D. SUNY DOWNSTATE SURGERY 11/7/13 CASE THE PATIENT IS A 79 YEAR OLD MALE WITH 3 DAY HISTORY OF LOWER ABDOMINAL PAIN, NAUSEA WITHOUT VOMITING, CHILLS

More information

General Surgery Service

General Surgery Service General Surgery Service Patient Care Goals and Objectives Stomach/Duodenum and Bariatric assessed for a) Obesity surgery b) Treatment of i) Adenocarcinoma of the stomach ii) GIST iii) Carcinoid 2) Optimize

More information

Resident Teaching Conference 10/16/09 Rondi Kauffmann Resident presenter William Nealon Faculty presenter

Resident Teaching Conference 10/16/09 Rondi Kauffmann Resident presenter William Nealon Faculty presenter Resident Teaching Conference 10/16/09 Rondi Kauffmann Resident presenter William Nealon Faculty presenter KC 59 year old male Referred to Surgery clinic for incidentally discovered 5cm x 3cm pancreatic

More information

Early management of complicated gallstones and acute pancreatitis

Early management of complicated gallstones and acute pancreatitis Early management of complicated gallstones and acute pancreatitis A/Prof Richard Cade George Kalogeropoulos ( Fellow) HPB/Upper GI Unit Eastern Health, Melbourne biliary colic/acute cholecystitis common

More information

BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT

BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT By: Amy Cisyk Home for the Summer Program July, 2016 Brandon, Manitoba Supervisor: Dr. Marvin Goossen Whipple s Procedure Audit

More information

Surgical Workload, Outcome and Research Database: V1.1

Surgical Workload, Outcome and Research Database: V1.1 Technical Guidance for Surgical Workload, Outcome and Research Database: V1.1 Contents 1. Standard Indicators... 5 1.1. Activity Volume... 5 1.2. Average Length of Stay (Days)... 5 1.3. 2/7/30 day Re-admission

More information

Severe necrotizing pancreatitis. ICU Fellowship Training Radboudumc

Severe necrotizing pancreatitis. ICU Fellowship Training Radboudumc Severe necrotizing pancreatitis ICU Fellowship Training Radboudumc Acute pancreatitis Patients with acute pancreatitis van Dijk SM. Gut 2017;66:2024-2032 Diagnosis Revised Atlanta classification Abdominal

More information

Acute pancreatitis Case reports. Clinical problems. Use of antibiotics? (P 1 & 2) Surgical treatment of AP? (P 3 & 4)

Acute pancreatitis Case reports. Clinical problems. Use of antibiotics? (P 1 & 2) Surgical treatment of AP? (P 3 & 4) Case reports Clinical problems Use of antibiotics? (P 1 & 2) Surgical treatment of AP? (P 3 & 4) Case reports Case 1 Case 1 Patient KD History M, 63 y Obesity BMI 30.3 kg/m 2 Gallbladder stones No concomitant

More information

Management of Gallbladder Disease

Management of Gallbladder Disease Management of Gallbladder Disease Steven B. Johnson, MD, FACS, FCCM Professor and Chairman, Department of Surgery Program Director, Phoenix Integrated Surgical Residency University of Arizona College of

More information

Severe and Tertiary Peritonitis

Severe and Tertiary Peritonitis Severe and Tertiary Peritonitis Addison K. May, MD FACS Professor of Surgery and Anesthesiology Division of Trauma and Surgical Critical Care Vanderbilt University Medical Center PS204: The Bad Infections:

More information

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important

More information

Types of peritonitis and management. J olita Augus te, PGY-5 SUNY Downs tate Grand Rounds 11/3/2016

Types of peritonitis and management. J olita Augus te, PGY-5 SUNY Downs tate Grand Rounds 11/3/2016 Types of peritonitis and management J olita Augus te, PGY-5 SUNY Downs tate Grand Rounds 11/3/2016 Case Presentation xx year old patient presents to ED with complaints of one day of abdominal pain s ince

More information

laparoscopic cholecystectomy

laparoscopic cholecystectomy Combined percutaneous and endoscopic approach in management of dropped gallstones following laparoscopic cholecystectomy John S.F. Shum 1*, K.H. Fung 1, George P.C. Yang 2, Chung Ngai Tang 2, Michael K.W.

More information

Management of Acute Pancreatitis

Management of Acute Pancreatitis Management of Acute Pancreatitis A Clinical Practice Guideline developed by the University of Toronto s Best Practice in Surgery JA Greenberg, M Bawazeer, J Hsu, J Marshall, JO Friedrich, A Nathens, N

More information

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.

More information

Emergency Surgery Course Graz, March ACUTE PANCREATITIS. Carlos Mesquita Coimbra

Emergency Surgery Course Graz, March ACUTE PANCREATITIS. Carlos Mesquita Coimbra ACUTE PANCREATITIS Carlos Mesquita Coimbra ESSENTIALS (1) AP occurs when digestive enzymes become activated while still in the pancreas, causing inflammation repeated bouts of AP can lead to chronic pancreatitis

More information

Antibiotic Therapy for Prophylaxis of Infection in Severe Pancreatitis is Overrated. Jessica Yu, R2 10/26/09

Antibiotic Therapy for Prophylaxis of Infection in Severe Pancreatitis is Overrated. Jessica Yu, R2 10/26/09 Antibiotic Therapy for Prophylaxis of Infection in Severe Pancreatitis is Overrated Jessica Yu, R2 10/26/09 Of 12 with pancreatitis 15% will get necrosis Of these, 40-70% progress to infection week 2-3

More information

National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH

National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

More information

Biliary tree dilation - and now what?

Biliary tree dilation - and now what? Biliary tree dilation - and now what? Poster No.: C-1767 Congress: ECR 2012 Type: Educational Exhibit Authors: I. Ferreira, A. B. Ramos, S. Magalhães, M. Certo; Porto/PT Keywords: Pathology, Diagnostic

More information

Long Term Follow-up. 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown. Is the patient alive? Yes No

Long Term Follow-up. 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown. Is the patient alive? Yes No Long Term Follow-up 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown Is the patient alive? Yes No Was an exam performed by a bariatric physician or PA/NP? Yes No Was the patient

More information

PATIENT DEMOGRAPHICS. Surname. Given name. Pacific Islander (non-maori) ADMISSION DETAILS

PATIENT DEMOGRAPHICS. Surname. Given name. Pacific Islander (non-maori) ADMISSION DETAILS Reviewer / hospital Date review started PATIENT DEMOGRAPHICS MRN DOB Sex Patient sticky label if available, else enter details here Surname Post-code Given name Australian Aborigine / TSI Middle Eastern

More information

Unusual case of pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography

Unusual case of pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography Yunen et al. 64 CASE REPORT OPEN ACCESS Unusual case of pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography Rafael Alba Yunen, King Soon Goh, Ugoagha

More information

Healthcare-associated infections acquired in intensive care units

Healthcare-associated infections acquired in intensive care units SURVEILLANCE REPORT Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units Key facts In 2015, 11 788 (8.3%) of patients staying in an intensive care unit

More information

Cholangitis/ Cholangiohepatitis Syndrome (Inflammation of the Bile Duct System and Liver) Basics

Cholangitis/ Cholangiohepatitis Syndrome (Inflammation of the Bile Duct System and Liver) Basics Glendale Animal Hospital 623-934-7243 www.familyvet.com Cholangitis/ Cholangiohepatitis Syndrome (Inflammation of the Bile Duct System and Liver) Basics OVERVIEW The liver is the largest gland in the body;

More information

Management of Pancreatic Fistulae

Management of Pancreatic Fistulae Management of Pancreatic Fistulae Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Fistula definition A Fistula is a permanent abnormal passageway between two organs (epithelial

More information

Setting The study setting was hospital. The economic analysis was carried out in California, USA.

Setting The study setting was hospital. The economic analysis was carried out in California, USA. Preoperative versus postoperative endoscopic retrograde cholangiopancreatography in mild to moderate gallstone pancreatitis: a prospective randomized trial Chang L, Lo S, Stabile B E, Lewis R J, Toosie

More information

Together, putting patients first

Together, putting patients first The Role of a Gastroenterologist in the Diagnosis and Management of Pancreatic Cancer Sarah Jowett, Consultant Gastroenterologist Bradford Teaching Hospitals Trust Leeds Regional Study Day, 12 September

More information

Surgical Management of CBD Injury Jin Seok Heo

Surgical Management of CBD Injury Jin Seok Heo Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence

More information

ERCP / PTC Surgical Laparoscopic vs open Timing and order of approach

ERCP / PTC Surgical Laparoscopic vs open Timing and order of approach Choledocholithiasis Which Approach and When? Lygia Stewart, MD University of California, San Francisco 2010 Naffziger Post-Graduate Course Clinical Manifestations of Choledocholithiasis Asymptomatic (no

More information

What can you expect after your ERCP?

What can you expect after your ERCP? ERCP Explained and respond to bed rest, pain relief and fasting to rest the gut with the patient needing to stay in hospital for only a few days. Some patients develop severe pancreatitis and may require

More information

Building Confidence in NHSN. Peg Gilbert, RN, MS, CIC, FAPIC Quality Improvement Advisor, Regional Task Lead Great Plains Quality Innovation Network

Building Confidence in NHSN. Peg Gilbert, RN, MS, CIC, FAPIC Quality Improvement Advisor, Regional Task Lead Great Plains Quality Innovation Network Building Confidence in NHSN Peg Gilbert, RN, MS, CIC, FAPIC Quality Improvement Advisor, Regional Task Lead Great Plains Quality Innovation Network Objectives Identify resources to improve reporting Examine

More information

Guess or get it right?

Guess or get it right? Guess or get it right? Antimicrobial prescribing in the 21 st century Robert Masterton Traditional Treatment Paradigm Conservative start with workhorse antibiotics Reserve more potent drugs for non-responders

More information

Q3 Sex Male Female. Q9b Pre-operative PPOSSUM Morbidity: Mortality:

Q3 Sex Male Female. Q9b Pre-operative PPOSSUM Morbidity: Mortality: Case Report Form Q1 Study ID Q2 Age at admission to study (years) Q3 Sex Male Female Q4 Comorbidities CCF Y/N COPD Y/N CVA Y/N Dementia Y/N Hemiplegia Y/N CKD Y/N Leukaemia Y/N DM(complicated) Y/N Lymphoma

More information

Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital

Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital Final Results Nathan Beahm, BSP, PharmD(student) September 10, 2016 Objectives Review background information

More information

ACG Clinical Guideline: Management of Acute Pancreatitis

ACG Clinical Guideline: Management of Acute Pancreatitis ACG Clinical Guideline: Management of Acute Pancreatitis Scott Tenner, MD, MPH, FACG 1, John Baillie, MB, ChB, FRCP, FACG 2, John DeWitt, MD, FACG 3 and Santhi Swaroop Vege, MD, FACG 4 1 State University

More information

Figure 2: Post-cholecystectomy biliary-like pain

Figure 2: Post-cholecystectomy biliary-like pain Figure 2: Post-cholecystectomy biliary-like pain 1 patient with recurrent episodes of pain (not daily), in the epigastrium/right upper quadrant, lasting >30 mins, building to a steady level, interrupting

More information

LOKUN! I got stomach ache!

LOKUN! I got stomach ache! LOKUN! I got stomach ache! Mr L is a 67year old Chinese gentleman who is a non smoker, social drinker. He has a medical history significant for Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus, Chronic

More information

West Yorkshire Major Trauma Network Clinical Guidelines 2015

West Yorkshire Major Trauma Network Clinical Guidelines 2015 WYMTN: Pelvic fracture with urogenital trauma KEY RECOMMENDATIONS 1. During the initial exploratory survey / secondary survey, a. The external urethral meatus and the transurethral bladder catheter (if

More information

Treatment of febrile neutropenia in patients with neoplasia

Treatment of febrile neutropenia in patients with neoplasia Treatment of febrile neutropenia in patients with neoplasia George Samonis MD, PhD Medical Oncologist Infectious Diseases Specialist Professor of Medicine The University of Crete, Heraklion,, Crete, Greece

More information

Abdominal ultrasound:

Abdominal ultrasound: Abdominal ultrasound: Non-traumatic acute abdomen Wittanee Na-ChiangMai, MD Department of Radiology ChiangMai University 26/04/2017 Contents Technique of examination Normal anatomy Emergency conditions

More information

Pneumonia Community-Acquired Healthcare-Associated

Pneumonia Community-Acquired Healthcare-Associated Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious

More information

a Total Hip Prosthesis by Clostridum perfringens. A Case Report

a Total Hip Prosthesis by Clostridum perfringens. A Case Report Haematogenous Infection of a Total Hip Prosthesis by Clostridum perfringens. A Case Report CHAPTER 5 CHAPTER 5 5.1. Introduction In orthopaedic surgery, an infection of a prosthesis is a very serious,

More information

Case Report Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient

Case Report Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient Case Reports in Medicine Volume 2015, Article ID 919452, 4 pages http://dx.doi.org/10.1155/2015/919452 Case Report Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient Eisha Wali,

More information

CASE SCENARIO EXERCISE

CASE SCENARIO EXERCISE påçííáëü=pìêîéáää~ååé=çñ=eé~äíüå~êé ^ëëçåá~íéç=fåñéåíáçå=mêçöê~ããé CASE SCENARIO EXERCISE CATHETER-ASSOCIATED URINARY TRACT INFECTION SURVEILLANCE SCOTTISH SURVEILLANCE OF HEALTHCARE ASSOCIATED INFECTION

More information

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005 Lutheran Medical Center Daniel H. Hunt, M.D. June 10 th, 2005 History xx y.o. pt with primary CBD stones s/p ERCP xx months earlier for attempted stone extraction resulting in post ERCP pancreatitis. Patient

More information

Management of Gallbladder Disease. Cory Buschmann, MD PGY-5 11/28/2017

Management of Gallbladder Disease. Cory Buschmann, MD PGY-5 11/28/2017 Management of Gallbladder Disease Cory Buschmann, MD PGY-5 11/28/2017 Financial disclosures None Content Scope of gallbladder diseases Evaluation H&P Labs Imaging Cholecystectomy vs cholecystostomy Ancillary

More information

Osteomyelitis Samir S. Shah, MD, MSCE

Osteomyelitis Samir S. Shah, MD, MSCE Osteomyelitis Samir S. Shah, MD, MSCE Professor, Department of Pediatrics University of Cincinnati College of Medicine Director, Division of Hospital Medicine Attending Physician in Infectious Diseases

More information

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Case Presentation 30 y.o. woman with 2 weeks of RUQ abdominal

More information

Abdominal Imaging - 9 Topics in 90 min

Abdominal Imaging - 9 Topics in 90 min Abdominal Imaging 9 topics in 90 min Antonio C. Westphalen, MD PhD Departments of Radiology and Biomedical Imaging, and Urology Liver Biliary tree Gallbladder Pancreas Kidneys Small bowel Colon Abscess?

More information

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 )

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Version 1.0 Page 1 of 3 Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Introduction Gallbladder is a sac connected to the biliary tree. It serves the function of concentration

More information

AMERICAN JOURNAL OF BIOLOGICAL AND PHARMACEUTICAL RESEARCH

AMERICAN JOURNAL OF BIOLOGICAL AND PHARMACEUTICAL RESEARCH AMERICAN JOURNAL OF BIOLOGICAL AND PHARMACEUTICAL RESEARCH e-issn - 2348-2184 Print ISSN - 2348-2176 Journal homepage: www.mcmed.us/journal/ajbpr ABDOMINAL ABSCESS A SEQUEL OF EXPLORATORY LAPAROTOMY FOR

More information

Bile Duct Injuries. Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India

Bile Duct Injuries. Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India Bile Duct Injuries Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India Introduction Bile duct injury (BDI) rare but potentially

More information

MHD I, Session III STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION III MHD I. Monday, September 16, 2013 STUDENT COPY

MHD I, Session III STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION III MHD I. Monday, September 16, 2013 STUDENT COPY MHD I, Session III STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION III MHD I Monday, September 16, 2013 STUDENT COPY MHD I, Session III STUDENT Copy Page 2 Helpful Session Resources: Murray

More information

Surgical Management of Acute Pancreatitis

Surgical Management of Acute Pancreatitis Surgical Management of Acute Pancreatitis Steven J. Hughes, MD, FACS Cracchiolo Family Professor of Surgery and Chief, General Surgery Overview Biliary pancreatitis a cost effective algorithm Key concepts

More information

Appendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound

Appendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound EFSUMB Newsletter 87 Examinations should encompass the full range of pathological conditions listed below A log book listing the types of examinations undertaken should be kept Training should usually

More information

Community Acquired & Nosocomial Pneumonias

Community Acquired & Nosocomial Pneumonias Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP

More information

Surgical Management of IBD. Val Jefford Grand Rounds October 14, 2003

Surgical Management of IBD. Val Jefford Grand Rounds October 14, 2003 Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two

More information

UPDATES IN ANTIBIOTIC THERAPY OF BILIARY TRACT INFECTIONS

UPDATES IN ANTIBIOTIC THERAPY OF BILIARY TRACT INFECTIONS 6 ARTICOLE ORIGINALE UPDATES IN ANTIBIOTIC THERAPY OF BILIARY TRACT INFECTIONS Cristian Balahura 1,2, Petre Iacob Calistru 1,3, Gabriel Constantinescu 1,2 1 Carol Davila University of Medicine and Pharmacy,

More information

Emergency Surgery Board Department of General Surgery Rambam Health Care Campus

Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Surgical Complications of Peptic Ulcer Disease Case Presentation and Review of the Literature Case Presentation 40y male

More information

Joint Trust Management of Acute Severe Pancreatitis in Adults

Joint Trust Management of Acute Severe Pancreatitis in Adults A clinical guideline recommended for use For Use in: By: For: Division responsible for document: All clinical areas (as a reference for screening) ITU/HDU (for definitive care) All medical staff likely

More information

Case Scenario 1. Discharge Summary

Case Scenario 1. Discharge Summary Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal

More information

DISCLAIMER. No Conflict of Interest

DISCLAIMER. No Conflict of Interest DISCLAIMER No Conflict of Interest EXCLAIMER No Interest in Conflict GALLSTONES FAQs and FACTS John Dunn, FRACS Laparoscopy Auckland YOU GOTTA KNOW THIS STUFF HOW DO THEY FORM? Gallbladder Lithogenic

More information

Endoscopic Management of Acute Pancreatitis. Theo Doukides, MD Gastroenterology and Therapeutic Endoscopy February 13, 2018

Endoscopic Management of Acute Pancreatitis. Theo Doukides, MD Gastroenterology and Therapeutic Endoscopy February 13, 2018 Endoscopic Management of Acute Pancreatitis Theo Doukides, MD Gastroenterology and Therapeutic Endoscopy February 13, 2018 Objectives Assessment of acute pancreatitis Early management Who needs an ERCP

More information

Acute Cholangitis. Kelsey Knotts PharmD Candidate Class of 2016

Acute Cholangitis. Kelsey Knotts PharmD Candidate Class of 2016 Acute Cholangitis Kelsey Knotts PharmD Candidate Class of 2016 Learning Objectives 1. Describe the mechanism of the development of acute cholangitis 2. Identify common causative organisms in acute cholangitis

More information

Technical Guidance for Surgical Workload Audit and Research Database: Cholecystectomy V1.0

Technical Guidance for Surgical Workload Audit and Research Database: Cholecystectomy V1.0 Technical Guidance for Surgical Workload Audit and Research Database: Cholecystectomy V1.0 Contents 1. The Indicators... 3 1.1. Activity Volume... 3 3.2. Average Length of Stay (Days)... 3 3.3. 2/7/30

More information

Neutropenic Fever. CID 2011; 52 (4):e56-e93

Neutropenic Fever.  CID 2011; 52 (4):e56-e93 Neutropenic Fever www.idsociety.org CID 2011; 52 (4):e56-e93 Definitions Fever: Single oral temperature of 101 F (38.3 C) Temperature 100.4 F (38.0 C) over 1 hour Neutropenia: ANC < 500 cells/mm 3 Expected

More information

Management of Acute Pancreatitis and its Complications Aspirus Grand Rounds June 6, 2017 Eric A. Johnson MD

Management of Acute Pancreatitis and its Complications Aspirus Grand Rounds June 6, 2017 Eric A. Johnson MD Management of Acute Pancreatitis and its Complications Aspirus Grand Rounds June 6, 2017 Eric A. Johnson MD Disclosure: None In accordance with the Standards of the Wisconsin Medical Society, all those

More information

Comparison between primary closure and T-tube drainage after open choledocotomy

Comparison between primary closure and T-tube drainage after open choledocotomy ISSN: 2203-1413 Vol.03 No.04 Comparison between primary closure and T-tube drainage after open choledocotomy Alireza Barband 1, Farzad Kakaei 1, Morteza Ghojazadeh 2, Abdolhamid Chavoshi Khamneh 1*, Morteza

More information

Surgical Complication, or Not, That Is the Question

Surgical Complication, or Not, That Is the Question Surgical Complication, or Not, That Is the Question Adriane Martin, DO, FACOS, CCDS Vice President Enjoin This is the Full Title of a Session Eads, TN 1 Learning Objectives At the completion of this educational

More information

Enhanced EARS-Net Surveillance 2017 First Half

Enhanced EARS-Net Surveillance 2017 First Half 1 Enhanced EARS-Net Surveillance 2017 First Half In this report Main results for 2017, first half Breakdown of factors by organism and resistance subtype Device-association Data quality assessment Key

More information

Expert rules. for Gram-negatives

Expert rules. for Gram-negatives Academic Perspective in Expert rules Emerging Issues of Resistance in Gram-ve Bacteria for Gram-negatives Trevor Winstanley Sheffield Teaching Hospitals Presented on behalf of David Livermore University

More information

Acute Pancreatitis:

Acute Pancreatitis: American College of Gastroenterology 2014 Acute Pancreatitis Scott Tenner, MD, MPH, FACG Clinical Professor of Medicine State University of New York Health Sciences Center Director, Brooklyn Gastroenterology

More information

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis Appendix with supplementary material. This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Supplementary Tables Table S1. Definitions

More information

PREVENTION AND TREATMENT OF BACTERIAL INFECTIONS IN CIRRHOSIS

PREVENTION AND TREATMENT OF BACTERIAL INFECTIONS IN CIRRHOSIS PREVENTION AND TREATMENT OF BACTERIAL INFECTIONS IN CIRRHOSIS Dr. J. Fernández. Head of the Liver Unit Hospital Clinic Barcelona, Spain AEEH Postgraduate Course, Madrid, February 15 2017 Prevalence of

More information

U Nordic Forum - Trauma & Emergency Radiology. Lecture Objectives. MDCT in Acute Pancreatitis. Acute Pancreatitis: Etiologies

U Nordic Forum - Trauma & Emergency Radiology. Lecture Objectives. MDCT in Acute Pancreatitis. Acute Pancreatitis: Etiologies Nordic Forum - Trauma & Emergency Radiology Lecture Objectives MDCT in Acute Pancreatitis Borut Marincek Institute of Diagnostic Radiology niversity Hospital Zurich, Switzerland To describe the role of

More information

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION Facts There were an estimated 157,500 surgical site infections associated with inpatient surgeries in 2011. SSIs were the most common healthcare-associated

More information

Guideline for management of children & adolescents with pleural empyema

Guideline for management of children & adolescents with pleural empyema CHILD AND ADOLESCENT HEALTH SERVICE PRINCESS MARGARET HOSPITAL FOR CHILDREN Guideline for management of children & adolescents with pleural empyema This guideline provides an evidence-based framework for

More information

ACUTE PANCREATITIS IN BERGEN, NORWAY

ACUTE PANCREATITIS IN BERGEN, NORWAY Scandinavian Journal of Surgery 93: 29 33, 2004 ACUTE PANCREATITIS IN BERGEN, NORWAY A study on incidence, etiology and severity H. Gislason 2, A. Horn 1, D. Hoem 1, Å. Andrén-Sandberg 1, A. K. Imsland

More information

University of Alberta Hospital Antibiogram for 2007 and 2008 Division of Medical Microbiology Department of Laboratory Medicine and Pathology

University of Alberta Hospital Antibiogram for 2007 and 2008 Division of Medical Microbiology Department of Laboratory Medicine and Pathology University of Alberta Hospital Antibiogram for 2007 and 2008 Division of Medical Microbiology Department of Laboratory Medicine and Pathology This material is supported in part by unrestricted educational

More information

What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer

What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer 9 Th Annual Symposium on Gastrointestinal Cancers, St. Louis University School of Medicine Carlos

More information

Shaun Yang, PhD, D(ABMM), MLS(ASCP) CM MB CM Assistant Professor of Pathology UNM Health Sciences Center Associate Director of Infectious Disease

Shaun Yang, PhD, D(ABMM), MLS(ASCP) CM MB CM Assistant Professor of Pathology UNM Health Sciences Center Associate Director of Infectious Disease Shaun Yang, PhD, D(ABMM), MLS(ASCP) CM MB CM Assistant Professor of Pathology UNM Health Sciences Center Associate Director of Infectious Disease Director of Molecular Infectious Disease TriCore Reference

More information

Pancreatic Benign April 27, 2016

Pancreatic Benign April 27, 2016 Department of Surgery Pancreatic Benign April 27, 2016 James Choi Dr. Hernandez Objectives Medical Expert: 1. Anatomy and congenital anomalies of the pancreas and pancreatic duct (divisum, annular pancreas

More information

The EM Educator Series

The EM Educator Series The EM Educator Series The EM Educator Series: Why is my patient with gallbladder pathology so sick? Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD

More information

Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai

Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai Original Research Article Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai S. Vijayalakshmi 1, Sriramchristopher M 2* 1 Associate

More information

Cholecystectomy (removal of the gallbladder) Patient Information

Cholecystectomy (removal of the gallbladder) Patient Information Cholecystectomy (removal of the gallbladder) Patient Information Author ID: MP Leaflet Number: Surg 060 Name of Leaflet: Cholecystectomy (removal of the gallbladder) Version: 1 Date Produced: October 2017

More information

Arteriovenostomy for renal dialysis 39.27, 39.42

Arteriovenostomy for renal dialysis 39.27, 39.42 Surgery categories NHSN Surgery codes (Reference: NHSN Operative Procedure Category Mappings to ICD-9-CM Codes, October 2010 www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf) Operative aortic aneurysm

More information

Surgical Privileges Form: General surgery. Clinical Privileges Request. Date:.. Recommended (For committee use) Under Supervision

Surgical Privileges Form: General surgery. Clinical Privileges Request. Date:.. Recommended (For committee use) Under Supervision Surgical Form: Clinical Request General surgery Applicant s Name:. License No. (If Any):... Scope of Practice:. Facility:.. Date:.. CATEGORY I: Basic Surgical skills 1. Insertion of Intravenous Line 2.

More information

What s new in Infectious Diseases. Petronella Adomako, MD Infectious Disease Specialist Mckay-Dee Hospital

What s new in Infectious Diseases. Petronella Adomako, MD Infectious Disease Specialist Mckay-Dee Hospital What s new in Infectious Diseases Petronella Adomako, MD Infectious Disease Specialist Mckay-Dee Hospital None Disclosures Objectives New information in infectious diseases. New diseases and outbreaks.

More information