gilbert
Forum Junior
Topics: 16
Posts: 45
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21. Six days after undergoing a laparoscopic cholecystectomy for acute cholecystitis, a 35-year-old woman comes to the physician because of fever and abdominal pain for 3 days. She is jaundiced. Her temperature is 38°C (100.4°F). Abdominal examination shows distention and incisions that are healing normally. Leukocyte count is 12,000/mm3, and total serum bilirubin level is 7.9 mg/dL. Which of the following is the most likely cause of the jaundice?
A ) Anesthetic-related hepatitis
B ) Common bile duct injury
C ) Fulminant hepatic failure
D ) Reaction to perioperative antibiotics
E ) Subhepatic abscess
E?
18. A 3-year-old boy with acute lymphoblastic leukemia has had fever for 3 days. He completed his last course of chemotherapy 6 days ago. He has had no malaise, rash, or anorexia and has had no known contact with sick children in preschool. He appears well. His temperature is 38.6°C (101.5°F), blood pressure is 75/60 mm Hg, pulse is 100/min, and respirations are 22/min. Examination shows normal findings. Laboratory studies show:
Hemoglobin 10.1 g/dL (N=11.5–15.5)
Leukocyte count 2200/mm3
Segmented neutrophils 5%
Bands 1%
Lymphocytes 65%
Atypical lymphocytes 11%
Monocytes 18%
Platelet count 35,000/mm3
Which of the following is the most appropriate next step in management?
A ) Schedule a follow-up visit and discharge without medication
B ) Observe him in the office for 3 hours; discharge without medication if examination remains unchanged
C ) Discharge him with oral broad-spectrum antibiotic therapy
D ) Admit him to the hospital for observation
E ) Admit him to the hospital for intravenous broad-spectrum antibiotic therapy
E?
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| nadiabarati
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yes I also say so
E
E
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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I have a query guys...Why can't 21 be Halothane induced hepatotoxicity..Fever,abdominal pain,jaundice and increased bilirubin fits in..
In subhepatic abscess, increased bilirubin -does it fits in??
Any suggestions!
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| Adam
Forum Senior
Topics: 6
Posts: 136
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21 >> Probably E ( I found it the most suitably, but still need more explanation)
18 >> E.
___________________
I will not say I failed 1000 times.. I will say that I discovered there are 1000 ways that can cause failure ..
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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I am confused about first question, why cant it be due to common bile duct injury during surgery.
I agree with all of you regarding second question.
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| klimt
Forum Guru
Topics: 27
Posts: 605
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I picked common bile duct, too....but the fever and high WBC count points indeed towards infection - so indecised about correct ans
and about second q, can anyone name some antibiotics that can be used in this situation?
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| doc-o8
Forum Elite
Topics: 30
Posts: 388
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B?
E.
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| doc-o8
Forum Elite
Topics: 30
Posts: 388
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fr sprint123.
halothane is nt used in US as anesthetic.(uw tip)
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| cirus
Forum Guru
Topics: 108
Posts: 740
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The ans for the first one is B..Charcots triad
Agree about the 2nd one
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| krsna
Forum Senior
Topics: 1
Posts: 211
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i thot it was B and E
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| Justice
Forum Fanatic
Topics: 106
Posts: 2,115
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(B)
(E)
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Don't live in a town where there are no doctors
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| goyal74
Forum Newbie
Topics: 0
Posts: 1
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Medicare recipients undergoing surgical removal of the gallbladder have a much higher post-operative mortality rate when they suffer a common bile duct injury during surgery, according to a study by UW and Medicare researchers.
The study of Medicare recipients undergoing cholecystectomies was conducted by a group led by David Flum, assistant professor of surgery at the UW. The results of the study, which centered on common bile duct (CBD) injury, one potential complication of cholecystectomy, were published in the Oct. 22 issue of the Journal of the American Medical Association. CBD injury occurs in about 1 in 200 cholecystectomies.
The researchers found that post-operative mortality was much higher in patients suffering a CBD injury during the procedure than in those patients without the injury. More than half of the cholecystectomy recipients without a CBD injury were alive at the last follow-up point, nearly 10 years after surgery, while only about one-fifth of those suffering the CBD injury were still alive then.
Among those patients who received surgery to repair the CBD injury, mortality was 11 percent higher when the same surgeon performed both the initial cholecystectomy and the injury repair. The experience of the surgeon performing the repair also affected mortality rate. The hazard for death decreased by 11 percent with each previous CBD repair performed by the surgeon.
This study was a follow-up to earlier work by the same group of researchers, who found that the risk for CBD injury was cut in half when surgeons perform a cholangiogram, or X-ray of the bile duct, during the cholecystectomy.
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| ashfaque
Forum Newbie
Topics: 0
Posts: 142
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C fulminant hepatic failure, with in 6 days of surery deranged LFTs and abdominal distention all favours C. although CBD injury possible
E.
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