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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.
“I have colon cancer and I’m here for surgery.”
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.
Positive for HTN, CAD, TIA, and chronic rhinitis. History of gastritis and anemia.
Tonsillectomy, left inguinal hernia repair, colonoscopy with biopsy.
Positive for smoking history of one-half of a pack daily; quit 20 years ago
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
Triamcinolone nasal spray, two sprays in the morning
Ferrous sulfate 325 mg PO TID
Multivitamin one PO once daily
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
He has the appearance of a normally developed white man who appears his stated age. He is alert, awake, and in no obvious distress.
BP 132/86 mm Hg, P 68 bpm, RR 11, T 37.1°C; Wt 69 kg, Ht 172.7 cm
Warm and dry. Multiple seborrheic dermatomes over the abdomen and chest.