hemicolectomy
DESCRIPTION
Surgical clinical case studyTRANSCRIPT
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HEMICOLECTOMY WITH DOUBLE HEMICOLECTOMY WITH DOUBLE
BARREL STOMA BARREL STOMA
KAVITHA SATHASIVANKAVITHA SATHASIVAN05/07/201205/07/2012
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• 47 yr old female was admitted to 3B on 18/06/12 for
colonoscopy scheduled on 19/06/12 to rule out any
possibilities of cancer after having altered bowel condition
(diarrhea and constipation) a/w vomiting 6 months ago.
• Colonoscopy result - tumours 30 cm from anal verge nearly
obstruct the lumen
• Exploratory Laparatomy with sigmoid colectomy with stoma
and HARTMANN'S procedure on 20/06/12
• Discharged on 27/06/12 with medication and TCA on
24/07/12 for colonoscopy.
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• Name : JN• Age : 57 yo• Gender : Female• Race : Malay• Height : 148cm• Weight : 56kg (18/06/12)• BMI : 25.57kg/m2
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• Electively admitted for colonoscopy (19/06/2012 )
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•Hx of breast abscess -> around 20yrs ago, had
surgery, told not cancer.
•Bronchial asthma
-On prophylaxis (MDI Budesonide & MDI Salbutamol)
-Last attack – last month
•Hypertension- On 3 Antihypertensive (T Perindropil 8mg OD, T Amlodipine 5mg OD, T Hydrochlorothiazide 25mg OD)
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• Does not consume Red meat regularly• No family hx of breast / colon/ thyroid ca • Housewife • Has 3 children • Breast fed all her children, youngest is 19yrs • Menopause for 5 years (not on HRT treatment)
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• BP : 143/96 mmHg• PR : 86 p/min• RR : 20 b/min• Temp : 37.0°C
•Hemicolectomy with double barrel Stoma
•Tumour at the descending colon
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DATE ISSUE WARD MANAGEMENT
RECOMMENDATION OUTCOME
18/06/12 Absence of antiemetic in tx of vomitingPt. been vomiting for the past 3 days
No antiemetic given on admission
Start IV Metoclopramide 10mg TDS
IV Metoclopramide started on 19/06/12-vomiting frequency reduced from x3/d to x1/d
18/06/12 Inappropriate administration time of fleet oralColonoscopy planned on 19/06/12 at 9am
Fleet Oral 45ml at 6pm, 9pm & 12MN
Should be given 12 hours & 2 hours before procedure (9pm on 18/06/12 & 7am on 18/06/12)
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DATE ISSUE WARD MANAGEMENT
RECOMMENDATION OUTCOME
19/06/12 Hydrochlorthiazide induced hypokalemiaPt is hypertensive & Potassium level is below range, improper K+ monitoring
T. Amlodipine 5mg, T. Perindropril 8mg, T. Hctz 25mg OD
•Withold HCTZ till hypokalemia is resolved•Monitor the K+ level
T. HCTZ was withheld on the 20/06/12
24/06/12 Inappropriate administration of T. Cefuroxime and T. metronidazole in chemoprophylaxis of surgerysurgery was on 20/06/12, not started with any abx
T. Cefuroxime 500mg BD + T Metronidazole 400 mg TDS started on 24/06/12
IV Cefoperazone 1g BD + IV Metronidazole 500mg TDS on 20/06/12 post-op
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DATE ISSUE RECOMMENDATION OUTCOME
27/06/12 Counseling on Fleet Oral as a discharge medication for colonoscopyColonoscope is on 27/7/12
1. Avoid fibre diet 3 days before the procedure: avoid vegetables, fruits with skins/seeds, nuts, whole grain cereal/breads.2. Only consume soft diets a day before the procedure until 6pm (eg. Soup, porridge)After 6pm, drink only clear liquids and juice. For food, can take plain jelly without added
fruits or toppings.
Pt Understood well
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Antihypertensive• Pt had sudden SOB on 24/06/12 night & BP shoot up to
150/89mmhg• pt was on T.perindropril 8mg OD and T.Amlodipine 5mg
OD• The T.amlodipine 5mg OD was converted to T.Felodipinie
5mg and patient tolerated & responded well.• The BP was under control.
1)Manzo BA, Matalka MS, Ravnan SL, Evaluation of a therapeutic conversion from amlodipine to felodipine, 2003 Nov;23(11):1508-12. http://www.ncbi.nlm.nih.gov/pubmed/14620396
2) Parra D, Beckev NP, Korman L , Retrospective evaluation of the conversion of amlodipine to alternative calcium channel blockers, 2000 Sep;20(9):1072-8, http://www.ncbi.nlm.nih.gov/pubmed/10999500
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1. Patient discharged on D of admission, with medication :-• T Celecoxib 200mg PRN x 10/7• C. Omeprazole 40mg OD x 2/52• T. Felodipine 5mg BD x 2/12• T. Perindropril 8mg OD x 2/12• T. Metronidazole 400mg TDS x 1/7• T. Prednisolone 40mg OM x 2/7 • T. Prednisolone 40mg ON x 1/7 • T. Cefuroxime 500mg BD x 1/7• Sol. Phospho Soda Oral 45ml BD ( for colonoscopy on 27/7/12)
CT TAP on 9/8/12 at Serdang Hosp
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1. Ministry of Health Malaysia. National Antibiotic Guideline. Malaysia: Ministry of Health; 2008. p. 24, 25, 29.
2. Scottish Intercollegiate Guidelines Network (SIGN): Antibiotic prophylaxis in surgery. A National Clinical Guideline. 2008 July. p. 6, 17, 29-31.
3. Kanji S, Devlin JW. Infectious diseases: Antimicrobial prophylaxis in surgery. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: a pathophysiologic approach.7 th ed. New York: McGraw Hill; 2008. p. 2030-1, 2036.
4. Thirion DJG, Guglielmo BJ. Infectious disorders: Antimicrobial prophylaxis for surgical infections. In: Koda-Kimble MA, Young LY, Alldredge BK, Corelli RL, Guglielmo BJ, Kradjan WA. Applied therapeutics: The clinical use of drugs.9th ed. US: Lippincott William & Wilkins; 2009. P57 p.1-10.
5. Manzo BA, Matalka MS, Ravnan SL, Evaluation of a therapeutic conversion from amlodipine to felodipine, 2003 Nov;23(11):1508-12. http://www.ncbi.nlm.nih.gov/pubmed/14620396
6. Parra D, Beckev NP, Korman L , Retrospective evaluation of the conversion of amlodipine to alternative calcium channel blockers, 2000 Sep;20(9):1072-8, http://www.ncbi.nlm.nih.gov/pubmed/10999500
7. Dante L. Haw, MD, Swartz principle of surgery 9th edition,benign condition of the colon and rectum/ benign tumors and polyps, september 2010, http://images.xixcalibur19.multiply.multiplycontent.com/attachment/0/TInHeQooCy0AACwxUfY1/surgery%20colon%20and%20rectum.pdf?key=uemed2012b:journal:755&nmid=364634932
8. Klikenberg-KnolEC, Jansen JM, Festen HP, Meiwissen SG, LamersCB, , Double-blind multicentre comparison of omeprazole and ranitidine in the treatment of reflux oesophagitis, Lancet 1987 Feb 14;1(8529):349-51, http://www.ncbi.nlm.nih.gov/pubmed/2880161
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