Complicated surgical infections
|
|
- Agnes Gilmore
- 6 years ago
- Views:
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 Name & Title Of Author: Dr Linda Jewes, Consultant Microbiologist Date Amended: December 2016 Approved by Committee/Group: Drugs & Therapeutics
More informationDisclosures. 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 informationBladder 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 informationIntra-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 informationHospital-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 informationGeneral'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 informationA 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 informationComprehensive 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 informationANZ 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 informationThe 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 informationJOHN 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 informationMANAGEMENT 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 informationGeneral 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 informationResident 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 informationEarly 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 informationBRANDON 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 informationSurgical 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 informationSevere 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 informationAcute 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 informationManagement 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 informationSevere 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 informationBrice 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 informationTypes 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 informationlaparoscopic 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 informationManagement 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 informationSevere 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 informationEmergency 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 informationAntibiotic 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 informationNational 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 informationBiliary 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 informationLong 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 informationPATIENT 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 informationUnusual 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 informationHealthcare-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 informationCholangitis/ 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 informationManagement 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 informationSetting 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 informationTogether, 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 informationSurgical 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 informationERCP / 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 informationWhat 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 informationBuilding 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 informationGuess 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 informationQ3 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 informationProspective 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 informationACG 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 informationFigure 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 informationLOKUN! 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 informationWest 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 informationTreatment 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 informationAbdominal 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 informationPneumonia 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 informationa 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 informationCase 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 informationCASE 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 informationLutheran 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 informationManagement 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 informationOsteomyelitis 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 informationManagement 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 informationAbdominal 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 informationInformation 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 informationAMERICAN 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 informationBile 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 informationMHD 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 informationSurgical 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 informationAppendix 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 informationCommunity 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 informationSurgical 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 informationUPDATES 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 informationEmergency 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 informationJoint 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 informationCase 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 informationDISCLAIMER. 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 informationEndoscopic 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 informationAcute 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 informationTechnical 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 informationNeutropenic 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 informationManagement 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 informationComparison 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 informationSurgical 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 informationEnhanced 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 informationExpert 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 informationAcute 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 informationISF 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 informationPREVENTION 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 informationU 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 informationSURGICAL 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 informationGuideline 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 informationACUTE 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 informationUniversity 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 informationWhat 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 informationShaun 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 informationPancreatic 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 informationThe 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 informationRetrospective 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 informationCholecystectomy (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 informationArteriovenostomy 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 informationSurgical 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 informationWhat 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