24 Intra-abdominal infections Flashcards Preview

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Flashcards in 24 Intra-abdominal infections Deck (16)
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1
Q

Define intra-abdominal infection.

A

Presence of micro-organisms in normally sterile sites within the abdominal cavity e.g. peritoneal cavity/hepatobiliary tree.
Excludes gastroenteritis.

2
Q

What are the three mechanisms of intra-abdominal infection?

A

Translocation from GU lumen to peritoneal cavity.
Translocation along a lumen.
Translocation of extra-intestinal source.

3
Q

Describe how a perforated appendix might form.

Presentation?

A

Obstructed lumen to vermiform appendix, stagnation, bacterial growth, pressure build up bursts.
Severe, generalised pain and shock.

4
Q

What are the complications of a perforated diverticulum? (3)

A

Diverticulitis.
Perforation.
Pericolic abscess.

5
Q

How might bowel cancer cause intraperitoneal infection?

Associated with which bloodstream infections?

A

Loss of bowel wall integrity.
Clostridium septicum.
Streptococcus gallolyticus.

6
Q

How do intra-abdominal post-operative infections occur?

A

Seeding at operation (reduced by prophylactic antibiotics).

Anastomotic leak.

7
Q

What is cholecystitis?

Presentation?

A

Inflammation of gallbladder wall associated with cystic duct obstruction (gallstones, malignancy, worms).
Fever, URQ pain, mild jaundice.

8
Q

What is empyema of the gallbladder?

Presentation?

A

Complication of cholecystitis - frank pus in gall bladder.

Severe pain, high fever, chills and rigors.

9
Q

What is cholangitis?

A

Inflammation/infection of upper biliary tree (hepatic and common bile ducts).

10
Q

What are the routes infection for a pyogenic liver abscess? (4)

A

Biliary obstruction.
Direct spread.
Haematogenous via mesenteric in hepatic portal vein or systemic via hepatic artery.
Penetrating trauma.

11
Q

What are the predisposing factors for an intra-peritoneal abscess? (6)

A
Perforation: ulcer/ appendix/ diverticulum.
Cholecystitis.
Infarction.
Necrosis.
Trauma.
Postoperative anastomotic leak.
12
Q

What is the presentation of an intra-peritoneal abscess?

A

Sweating, anorexia, wasting, high swinging pyrexia.
Subphrenic: shoulder pain, hiccup, apparent hepatomegaly, ipsilateral lung collapse + pleural effusion.
Pelvic: urinary frequency and tenesmus.

13
Q

What are hydatid cysts caused by?

A

Echinococcus granulosus.

14
Q

Which organisms cause intrabdominal infections? (7)

A
Enterobacteriaceae: E.coli.
Pseudomonas.
Bacteroides spp. Prevotella spp.
Enterococcus. Streptococci.
Clostridium.
15
Q

What is the empirical therapy for intestinal source intra-abdominal infection?

A

Cefuroxime + metronidazole.
Piperacillin/tazobactam is over 65.
And pus drainage if intraperitoneal abscess.

16
Q

What do blood tests show in intra-abdominal infections?

A

Neutrophilia/neutropenia.
Raised C-reactive protein.
Abnormal LFT’s if hepatobiliary.

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