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The first prophylactic antibiotic dose should
provide a sufficient antibiotic serum level
throughout the surgery to combat organisms
The first dose be timed to occur within 60
minutes before the surgical incision is made.
If a fluoroquinolone or vancomycin is chosen for
administered within 120 minutes of the start of
For most surgeries, the use of prophylactic
antibiotics should end within 24 hours after
Cefazolin or cefuroxime are suggested for
prophylactic antibiotics up to 72 hours to
Cardiothoracic Cefazolin or cefuroxime; if beta 72-hour duration
lactam allergy, vancomycin or advocated by some, but
24 hours is likely to be
Cefazolin or cefuroxime; if beta
lactam allergy, vancomycin
with or without gentamicin, or
Oral: neomycin, with
Combination of oral and
erythromycin base or
may decrease infection
Adapted with permission from Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004,38:1707.
Adapted with permission from Bratzler
DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004,38:1707.
Incidence of incarceration ~10% among
Cannot be reduced into the abdominal
Strangulated hernias have incarcerated
Frequently, intense pain is caused by
Incarcerated inguinal hernias present with
abdominal distention, pain, nausea, and vomiting due to intestinal obstruction.
Plain abdominal X-rays may verify
intestinal obstruction in cases of incarceration.
Etiology for extensive resection:
Congenital anomalies leading to short bowel syndrom include –
Midgut volvulus w/ intestinal necrosis
Extensive resection due to malignancy.
Resection resulting in less than 120cm of intact
Resection of up to 50% of smal bowel is
Resection of up to 70% is tolerated if terminal
Infants may tolerate upto 85% of smal bowel
Loss of the ileocecal valve results in rapid
emptying of enteral contents into the colon and reflux of colonic bacterial flora into smal bowel.
The entire jejunum can be resected
without serious adverse nutritional sequela.
Cel ular hyperplasia and bowel hypertrophy
occur over a 2- to 3-year period, increasing the absorptive surface area.
Fat absorption is most likely permanently
Hyperoxaluria & Nephrolithiasis
Gastric hypersecretion – in early postop period.
Increased acid load may injure distal bowel mucosa hypermotility & impaired absorption.
Cholelithiasis – altered bilirubin metabolism after
ileal resection increased risk of pigmented gal stones stones that is 2nd to a decreased bile salt pool. TPN also may lead to increased risk of cholelithiasis.
Hyperoxaluria & Nephrolithiasis –
Excessive fatty acids within the colonic lumen
Unbound oxalate that normal y is made
insoluble by Ca-binding and is excreted in feces is thus, readily absorbed.
This results in hyperoxaluria and calcium
Caused by rapid intestinal transit.
Presence of hyperosmolar enteric contents.
Disruption of enterohepatic bile acid
Fat absorption is most severly impaired by
Loss of ileocecal valve permits reflux of
Intestinal dysmotility increases colonization. Bacterial overgrowth & change in flora results
in pH alteration & deconjugation of bile salts.
This results malabsorption, fluid loss,
Irreversibly acetylates cyclooxygenase
Results in inhibiting plt synthesis of
Higher doses than > 80 – 160mg PO / day
GPC – streptoccocci
, syphilis, GPR - Neisseria m., C. perfringens,
Not effective for Staph
Ampicil in/amoxicil in: PCN + Enterococcus
coverage Unasyn: PCN + GPC (staph & strep), GNR +/-
NOT FOR Pseudomonas, Acinetobacter, or Serratia.
Sulbactam & Clavulanic acid – are beta-lactamase
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