Post Lap Cholecystectomy Case Study

Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).

A 67year old female patient was scheduled for a laparoscopic hysterectomy. However 5 weeks prior to hospitalization she was hospitalized and the case was converted to an open procedure due to excessive bleeding. After being discharged she developed fever and drainage and was readmitted again for possible postoperative infection seven days ago. On day two of admission she underwent surgery for post operative abscess and insertion for a central line for long-term antibiotics.

The most common indication for laparoscopic liver resection is a solitary liver metastases from colorectal cancer, but it may also be due to hepatocellular carcinoma and for benign liver tumors or cysts. On the other hand, open surgical resection to remove the affected part of the liver, is the standard treatment for patients with localized hepatocellular carcinoma. Other alternatives to this treatment include hepatic artery infusion chemotherapy, percutaneous ethanol injection, cryoablation, microwave coagulation therapy, laser induced thermotherapy and radiofrequency ablation.

The patient is a 69-year-old woman who has COPD, and asthmatic bronchitis; who presents for evaluation of increasing shortness of breath, cough, and increased sinus congestion and pressure. She has been on steroids because of exacerbation of asthma now for some time, is actually on 40 mg daily. In spite of this she notes ongoing wheezing, and shortness of breath when doing her exercise tolerance. She has had no high fevers, no localized chest pain. She is using her inhalers as prescribed. Others at time in [Place] have also had an upper respiratory illness. She wanted to make sure she would not need antibiotics. She has had some facial pain, that seems to better today. She had some yellow discharge that now seems to be clear. The patient did

Humans are suffering from the urolithiasis from time before the recorded history. Urolithiasis have been found in the Egyptian mummy dating 4800BC(1).Surgery for urolithiasis was done in ancient Greek and Roman civilizations but these surgeries were mainly focused as treatment for complications of stone diseases like pyonephrosis or fistulae. Ingalls performed first elective nephrolithotomy in 1872 in United States of America and Morris performed first elective nephrolithotomy in England in 1880(2).

Cholecystectomy, the gold standard for cholelithiasis, until the institution of laparoscopic cholecystectomy.[92] Cholecystectomy requires hospital stay , and has death rate of less than one percent.[93,94] Disadvantages to open cholecystectomy are the resulting pain and weeks of disability.[97] A patient who has had abdominal surgery a number of times may not be a appropriate candidate for Laparoscopic cholecystectomy because of broad adhesions around the gallbladder.[26] Patients who are therapeutically too unstable to undergo open cholecystectomy are also not a good candidate for Laparoscopic cholecystectomy either. The estimation and treatment of the stones in the common bile duct can be carried out by endoscopic retrograde cholangiopancreatography

We did initially have her on antibiotics to cover the possibility of of a bacterial lower respiratory tract infection, but given that there was noting grown on sputum and the RSV seen on the nasopharyngeal swab, this was stopped while she was an inpatient.

Alves, Pedro Henrique Ferreira Alvesa, Rissi, Eduardo Silvaa, Adilson Rodriguesa, Carlos Menegozzoa, Edivaldo M Utiyamaa

H was admitted to the Inpatient Telemetry Unit of the hospital due to cough, dyspnea, and weakness secondary to pneumonia. During hospitalization, CT angiogram of chest was done which revealed consolidation involving the right upper, middle, and lower lobes which could be could be infectious or malignant in nature, as well as adjacent patchy and nodular opacity, also nodular and ground glass opacity in left lung, where findings most consistent with multifocal pneumonia. Afterwards, she was placed on continuous telemetry monitoring and oxygen per protocol to keep saturations greater than 94%. As well as sputum culture and blood cultures were sent, where it revealed the presence of 1+ normal oropharyngeal flora. Her significant laboratory findings revealed WBC count of 3.4 (dropped down from 11.9; noted low), hemoglobin 9.3 (dropped from 11.9; noted low), hematocrit 28% (dropped from 35.4%; noted low), and glucose of 187 (elevated from 108; noted high). MRI brain with and without contrast was done showed left maxillary sinus disease, while interventional radiologists tunnel central venous access device with port was placed via the left internal jugular vein with the tip of the catheter in the superior vena cava/right atrial junction and the port in the left chest. Afterwards, Levofloxacin 750mg in 150ml D5 water to her medication together with morphine 2 - 6 mg IV Push 4 hourly for pain was added. The biopsy of her right lung confirmed recurrence of small cell cancer. Consulted her oncologist and recommended to restart chemotherapy. After the management of her infection, the Oncology Department provided palliative treatment chemotherapy using carboplatin and

The patient had no evident comorbidities. An IV antibiotic regimen was begun and after 5 days,

intercostal nerves and results in central nervous system hyperexcitability. The exact cause and pathway of this pain in not well understood. However, the intercostal, phrenic, and vagus nerves have all been associated with the cause of pain (Conlon, Shaw, & Grichnik, 2008). During the postoperative period, the patient must be able to clear secretions through coughing and deep breathing. Inability to perform these tasks can lead to atelectasis, bronchial obstruction with the potential for bacterial colonization and parenchymal lung infection. These pulmonary issues can further progress to systemic complications such as, sepsis, hypoxemia, intrapulmonary shunting, and progress to cardiovascular failure (Kaiser, Zollinger, Lorenzi, Largiader, & Weder, 1998).

HEENT: Head: No tenderness to maxillary or frontal sinus cavities on palpation. No pain at temporomandibular joint. Eyes: Pupils round, reactive to light and accommodation. Conjunctiva was pink, sclera identified to be white Ears: Pinna visible and intact, tympanic membrane grey, and no erythema noted. Nose: Septum midline, no airway obstruction noted, no visible nasal discharge or flaring noted. Throat: tonsils visible and were grade 1+ and parotid glands were not identified on examination. Oral mucosa appears dry.

This patient would need to be hospitalized for immediate, aggressive management with antibiotics and corticosteroids (Domingo & Barquet,

On the initial presentation to Emergency department with worsening dyspnoea, dry cough and neck tightness. The patient was afebrile, acyanotic, tachypnoiec (respiratory rate of 36 per minute), tachycardic (heart rate of 166 per

Strep throat is not the only disease caused by Streptococcus pyogenes. All cases of symptomatic Strep throat should be treated with antibiotics to prevent the progression of infection to more serious disease. There are many diseases linked to complications of S. pyogenes infection. Localized skin infections (impetigo)1, erysipelas, and cellulitis all result from the spread and multiplication of Streptococcus pyogenes into deeper layers of skin and muscle fascia. Necrotizing fasciitis (flesh-eating bacteria) is a recognized result of this spread, which more often than not requires immediate surgery to remove the dead and permanently damaged tissue5. As bacteria spread, they can lead to localized infections throughout the body. Such as tonsils (tonsillitis), skin (cellulitis), muscle (myositis), sinuses (sinusitis), middle ear (otitis media), and even blood (septicemia)4. Bacterial toxins also prove dangerous, as they have been linked to scarlet fever,