Week 2: Surgery

Session 1 Assignment: Present a patient with the chief complaint of severe abdominal pain and a diagnosis of acute pancreatitis

Acute Pancreatitis Case

Yellow arrows showing colon cut-off sign
CT scan showing fat stranding around the pancreas

Session 1 Assignment: What are the indications for surgical or endovascular intervention in lower extremity PAD? Also contrast this with the indications for intervention in carotid artery disease.

Indications for PAD intervention:

  1. Claudication that limits quality of life – limits social activities, exercise, or work
  2. Pain at rest
  3. Tissue loss (ulcerations, gangrene)

Indications for carotid endartarectomy:

  1. Severe stenosis (>70%) with at least 5 years life expectancy, plus all of the following:
    1. Surgically accessible carotid lesion
    2. Absence of clinically significant cardiac, pulmonary, or other disease that would increase the risk of anesthesia or surgery
    3. No prior ipsilateral endarterectomy

Indications for carotid stenting:

  1. Severe stenosis (>70%), plus any of the following:
    1. Carotid lesion that is not suitable for surgical access
    2. Radiation induced stenosis
    3. Restenosis after endarterectomy
    4. Clinically significant cardiac, pulmonary, or other disease that would increase the risk of anesthesia or surgery

With both: CVA/TIA risk/ previous CVA/TIA

Revascularization in the case of PAD is mostly dependent on severity of disease, whereas carotid interventions are more based on symptoms

Session 3 Assignment: If you could only use 5 antibiotics as a clinician, which would you choose and why?

In considering which 5 antibiotics I would choose, I wanted to make sure to be able to cover the following:
  • Gram positives
  • Gram negatives
  • Anaerobes
  • MRSA
  • Pseudomonas aeureginosa
With that in mind, I chose the following:
  1. Augmentin
    1. Good gram positive and gram negative coverage, plus some anaerobic coverage
    2. Appropriate for mild-moderate infections
    3. Good for otitis media, sinusitis, strep, skin and soft tissue infections, human/animal bites, bronchitis, UTI, etc.
  2. Azithromycin
    1. Good for penicillin-allergic patients
    2. Treats atypical pneumonias, legionella, some STIs, Lyme Disease, etc.
  3. Ceftriaxone
    1. Good gram positive and gram negative coverage, plus some anaerobic coverage
    2. Crosses the blood-brain barrier
    3. Treats lower respiratory infections, skin infections, UTI, PID, chlamydia, meningitis, bone and joint infections, etc.
  4. Meropenem
    1. Severe infections, really broad
    2. Covers pseudomonas aeureginosa
  5. Vancomycin
    1. Severe infections
    2. Covers MRSA
    3. Treatment for C. difficile
I think the antibiotics I chose cover a nice range of infection severity from mild to severe, and many different types of organisms.
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