133b Intraabdominal infections Flashcards Preview

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Flashcards in 133b Intraabdominal infections Deck (18):
1

typhalitis
cause?
outcome?

chemo injures mucosa + neutropenia --> microbial invasion of bowel wall and necrosis

high mortality

2

primary peritonitis (aka spontaneous bacterial peritonitis)
cause?
spread?
presentation?
dx?

cirrhosis and ascites --> bacterial peritonitis without inciting event

spread from blood, lymph, vagina

presentation - worse encephalopathy

dx - >250 neutrophile on paracentesis

3

secondary peritonitis - cause?

bowel contents spill into cavity

4

diagnosis of SBP

paracentesis >250 PMNs

only 1 bacteria

5

secondary paritonitis - pathogenesis and number of organisms?

spillage of gut bugs into cavity + other things (bile, gastric juice, etc)

multiple organisms (unlike SBP)

6

etiology of SBP

E Coli
Klebsiella
Steptococcus pneumoniae

7

where is highest concentration of bacteria and risk for secondary peritnonits?

colon

8

secondary peritonitis clincal presentation?

lies with knees flexed
rebound tenderness
ab wall rigidity

WBC w/ left shift

**different than SBP with low WBCs --> not much of a reaction**

9

visceral abscess

from underlying organ injury

blood spread for monomicrobial

communication with bowel lumen for polymicrobes

10

Secondary peritonits dx

high WBC with left shift

ileus on xray

free air in chest xray

11

sec perit rx

broad antibiotics

surgery

drainage

12

CAPD Peritonitis - pathogensis

from catheter -- biofilms

staph epidermidis/aureus

Rx - antibiotics via dialysate

preventation - sterile technique and topical antibiotics to catheter

13

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

14

splenic abscess

always blood spread - infective endocarditis

untreated - 100% death

15

diverticulitis

perforation of herninations of mucosa through muscalaris layer - sigmoid and descending colon

resembles acute appendicitis but on left side

16

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

17

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

18

CT scan confirms acute appendicitis, perforation and peri-appendiceal abscess. Empiric antibiotic therapy should be directed against which microorganisms?

Aerobic gram negative bacilli and anaerobes