Antibiotic Common side Effects.
Vancomycin- Redman syndrome, Nephrotoxicity
Bactrim- Hemolytic An, Steven johnson
Clindamycin- C Diff colitis
Flagyl- Disulfiram like reaction, teratogenic, peripheral neuropathy
What is Health care associted MRSA?
MRSA infection occur >48 hour following hospitalization or MRSA infection occur outside of hospital within 12 month exposure to healthcare (h/o surgery, hospitalization, dialysis or residence in long term care facility)
Coverage for MRSA?
VANCOMYCIN drug of Choice
LInezoid, Synercid second line
ANTI-TB DRUG SIDE EFFECTS
INH- Hepatotoxicity, B6 deficiency
Ethambutol- Retrobulbar Neuritis
Effective Against Enterococccus
Vanco, Timentin/Zosyn, Ampicillin/amoxicillin, gent with ampicillin
DRUG MOA quinolone
quinolone -inhibit DNA Gyrase
rifampin- inhibit RNA polymerase
metronidazole- produce o2 radiclar break DNA
sulfonamide- PABA analogue
trimethoprim- inhibit dihydrofolate reductase
acyclovir- inhibit DNA polymerase
isoniazid- inhibit mycolic acid
amphotericin-bind sterols in wall and alter membrane permeability
Classification of Diverticulitis
Diverticulitis with associated pericolic abscess
Diverticulitis associated with distant abscess (retroperitoneal or pelvic)
Diverticulitis associated with purulent peritonitis
Diverticulitis associated with fecal peritonitis
Hinche classification subdivision
Stage I has been subdivided into Ia that is pericolic inflammation. Stage Ib is diverticulitis associated with pericolic abscess. Stage IIa is distant abscess amenable to percutaneous drainage.Stage IIb is complex abscess with or without fistula.
When should you get surgery after diverticulitis?
Elective resection has generally been offered to patients who have suffered two attacks of acute diverticulitis in a short period of time, but recommendations have ranged from one to four episodes. Data suggest recurrences of up to 67%, with higher morbidity (up to 60%) and mortality associated with recurrent diverticulitis particularly after two episodes.
Layers of TRUS
Accuracy of TRUS for Rectal cancer?
TRUS is superior for T staging of rectal cancer. The range of the accuracy of TRUS is 80–95% compared with 65–75% for CT scan, 75–85% for MRI, and 62% for DRE.
TRUS understages more frequently than overstages the primary rectal tumor. However, TRUS understages the cancer less often than CT scan (15 vs 39%)
PET for rectal Cancer
(FDG-PET) is effective in assessing the extent of pathologic response of primary rectal cancer to preoperative chemoradiation and may predict long-term outcome.
that PET scans not be used routinely in the standard workup of a rectal cancer.
Stage of Rectal cancer
In stage I disease, the tumor may invade into the muscularis propria. In stage II disease, the tumor invades completely through this layer into the perirectal fat (T3) or adjacent organs (T4). Any lymph node metastasis represents stage III disease, and metastatic spread denotes stage IV disease.
TNM of rectal cancer
T1- Tumor invades submucosa
T2-Tumor invades muscularis propria
T3- Tumor invades through muscularis propria into the subserosa or into nonperitonealized pericolic or perirectal tissues
T4a- Tumor perforates visceral peritoneum
T4b - Tumor directly invades other organs or structures
Regional lymph nodes (N)
N1 - Metastasis in 1–3 regional lymph nodes
N1a - Metastasis in 1 regional lymph node
N1b - Metastasis in 2–3 regional lymph nodes
N1c Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis