Flashcards in 133b Intraabdominal infections Deck (18):
chemo injures mucosa + neutropenia --> microbial invasion of bowel wall and necrosis
primary peritonitis (aka spontaneous bacterial peritonitis)
cirrhosis and ascites --> bacterial peritonitis without inciting event
spread from blood, lymph, vagina
presentation - worse encephalopathy
dx - >250 neutrophile on paracentesis
secondary peritonitis - cause?
bowel contents spill into cavity
diagnosis of SBP
paracentesis >250 PMNs
only 1 bacteria
secondary paritonitis - pathogenesis and number of organisms?
spillage of gut bugs into cavity + other things (bile, gastric juice, etc)
multiple organisms (unlike SBP)
etiology of SBP
where is highest concentration of bacteria and risk for secondary peritnonits?
secondary peritonitis clincal presentation?
lies with knees flexed
ab wall rigidity
WBC w/ left shift
**different than SBP with low WBCs --> not much of a reaction**
from underlying organ injury
blood spread for monomicrobial
communication with bowel lumen for polymicrobes
Secondary peritonits dx
high WBC with left shift
ileus on xray
free air in chest xray
sec perit rx
CAPD Peritonitis - pathogensis
from catheter -- biofilms
Rx - antibiotics via dialysate
preventation - sterile technique and topical antibiotics to catheter
intraperitoneal abscess - what is it? what organism causes it? symptoms?
fibrous capsule contains infectious organisms w/ PMNs; prevents spread
Bacteroides fragilis + polymicrobial
fevers, chills, pain, tenderness over area
always blood spread - infective endocarditis
untreated - 100% death
perforation of herninations of mucosa through muscalaris layer - sigmoid and descending colon
resembles acute appendicitis but on left side
A patient with alcoholic cirrhosis, portal hypertension presents with hepatic encephalopathy and tense ascites.Which test is most likely to diagnose spontaneous bacterial peritonitis (SBP)?
Peritoneal fluid neutrophil count
A 52 yo male previously healthy presents with abdominal pain, nausea, vomiting and fever. On abdominal exam, you identify RLQ tenderness, guarding and rebound.Which of the following is the likely diagnosis?
Acute perforated appendicitis