127 - Intraabdominal Infections and Abscesses

Question 1

Abdominal cavity infections occur in two phases:__ followed by __

Answer 1

peritonitis

abscess

Question 2

What are the 4 etiologies of PBP (primary bacterial peritonitis)

Answer 2

liver cirrhosis due to alcoholism
malignancy
post necrotic cirrhosis
viral hepatitis

Question 3

PBP is found in >= _% of patients with cirrhosis

Answer 3

10

Question 4

The clinical signs of PBB are: 4

Answer 4

fever
ascites
acute abdominal pain + peritoneal signs
general signs (malaise/encephalopathy/lethargy)

Question 5

We should suspect PBP in patients with ascites + __. In this case sample __

Answer 5

fever

peritoneal fluid

Question 6

PBP diagnosis can be established when PMN > __ in peritoneal fluid

Answer 6

250 cells/microliter

Question 7

CT + contrast is used to rule out __ source of infection when >_ pathogens are cultured.

Answer 7

intraabdominal

1

Question 8

What are the common pathogens causing PBP?

Answer 8

E.coli
strep
enterococci/pneumococci
ESBL

Question 9

What is the empiric treatment for PBP?

Answer 9

cefotaxime (3rd gen cephalosporines)

penicillin (piperacillin/tazobactam) or ceftriaxone

Question 10

Which Abx should be used If PBP is nosocomial?

Answer 10

carbapenem

Question 11

Which PBP patients may benefit from albumin? 3

Answer 11

Cr >= 1 mg/dL
BUN >= 30 mg/dL
bilirubin >= 4 mg/dL

Question 12

Treating PBP usually achieve an improvement within the first __ hours, and should be continues for __ days in total unless bacteremia/slow improvement- in that case continue for __ weeks. If __ are found in the peritoneal fluid, look for a different source

Answer 12

72
5
2
WBC

Question 13

Which patients may benefit from prophylactic Abx to prevent PBP?

Answer 13

peritoneal fluid protein > 1.5 mg/dL + renal failure
and/or
liver failure

livre cirrhosis + GI bleeding

Question 14

_% of patients with PBP will experience relapse within the __ year

Answer 14

70

following

Question 15

Peritonitis in ambulatory peritoneal dialysis patients usually involve __ pathogens. In most cases __ pathogen is responsible.

Answer 15

cutaneous

1

Question 16

In peritonitis of ambulatory peritoneal dialysis patients the dialysate looks __, with > __ WBC, >_% _. Treatment may be dripped directly to the __.

Answer 16

cloudy
100 
50
neutrophils 
peritoneum

Question 17

דילגתי על Intraperitoneal abscess

Answer 17

דילגתי על Intraperitoneal abscess

Question 18

The liver is the most prone organ to develop __. The most common etiologies are __ and __

Answer 18

abscess
biliary disease
pylephlebitis

Question 19

pylephlebitis=__

Answer 19

is defined as an inflamed thrombosis of the portal vein

Question 20

The clinical presentation of liver abscess include: 4

Answer 20

• fever
• RUQ pain
• unspecific signs (chills/weight loss/anorexia/nausea+ vomiting)
• hepatomegaly/jaundice

Question 21

The most indicative lab result for liver abscess is __ (70% of patients). 50% of patients may show elevated __ and __

Answer 21

elevated ALP
bilirubin
AST

Question 22

Other more general lab results of patients with liver abscess include: __, __, __, __

Answer 22

leukocytosis
normo-normo anemia
hypoalbuminemia
bacteremia

Question 23

The gold standard imaging test for liver abscess are:__ and __

Answer 23

US

CT

Question 24

What is the main treatment of liver abscess?

Answer 24

surgical/percutaneous drainage

Question 25

Surgical drainage reduce hospitalization by __

Answer 25

half

Question 26

What are the indications for surgical drainage?

Answer 26

number of abscess
big abscess
the content blocks the tube
another surgical disease 
no response to percutaneous drainage within 4-7 days

Question 27

What is the most common infection leading to splenic abscess?

Answer 27

endocarditis

Question 28

דילגתי על perinephric and renal abscess

Answer 28

דילגתי על perinephric and renal abscess