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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recommend appropriate antimicrobial prophylaxis for a given surgical procedure.

  • Discuss the timing of antimicrobial prophylaxis for surgery, including doses prior to and after surgery.

  • Describe the controversy regarding mechanical bowel preparation prior to colorectal surgery.

  • Identify the pros and cons to using oral antimicrobial decontamination prior to colorectal surgery.

  • Evaluate the need for perioperative antiplatelet therapy in a specific surgical patient.

PATIENT PRESENTATION

Chief Complaint

“I have colon cancer and I’m here for surgery.”

HPI

Edward Adler is a 72-year-old man who was recently diagnosed with anemia and generalized weakness. The workup for anemia included a colonoscopy, which showed a malignant neoplasm of the proximal ascending colon. The neoplasm was identified, and the biopsy revealed moderately differentiated adenocarcinoma. The patient denies any current abdominal pain or change in bowel habits but reports a 20-lb weight loss over the past several months. He is eating but has less of an appetite than normal.

PMH

Positive for HTN, CAD, TIA, and chronic rhinitis. History of gastritis and anemia.

PSH

Tonsillectomy, left inguinal hernia repair, colonoscopy with biopsy.

SH

Positive for smoking history of one-half of a pack daily; quit 20 years ago

Meds

Metoprolol succinate 50 mg PO daily

Hydrochlorothiazide 12.5 mg PO daily

Atorvastatin 40 mg PO daily

Sertraline 100 mg PO daily

Omeprazole 20 mg PO daily

Aspirin 81 mg PO daily

Triamcinolone nasal spray, two sprays in the morning

Ferrous sulfate 325 mg PO TID

Multivitamin one PO once daily

All

None

ROS

Cardiopulmonary: Denies chest pain, shortness of breath, or wheezing

Gastrointestinal: Denies history of hepatitis, ulcers, or jaundice

Genitourinary: He has no history of hematuria or renal calculi

Psychiatric: Positive for depression

Physical Examination

Gen

He has the appearance of a normally developed white man who appears his stated age. He is alert, awake, and in no obvious distress.

VS

BP 132/86 mm Hg, P 68 bpm, RR 11, T 37.1°C; Wt 69 kg, Ht 172.7 cm

Skin

Warm and dry. Multiple seborrheic dermatomes over the abdomen and chest.

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