Day 2- STD's and intraabdominal infections Flashcards
What 3 parts are in the peritoneum and which one shows localized and diffuse pain?
What’s the difference between uncomplicated and complicated IAI’s?
What is the difference between peritonitis and an abscess and what is primary peritonitis?
Parietal peritoneum, Visceral peritoneum, peritoneal cavity(usually holds <100 ml). Parietal is localized, Visceral is diffuse.
Complicated extend beyond a single organ.
Peritonitis is an inflammation of the peritoneal lining, abscess is a pocket of purulent fluid. Hematogenous spread causing peritoneal inflammation.
Do PPI’s cause spontaneous bacterial peritonitis?
What is the pathophysiology of SBP and what is the most common cause of ascites?
What is the most common bacteria in SBP and then with cirrhotic ascites?
YES(2x3 fold increase).
Fluid and protein shift(third spacing) may be so dramatic that circulating blood is decreased and this could lead to hypovolemic shock. Alcoholic cirrhosis.
S.Pneumoniae. E.coli followed by klebsiella.
Which type of bacteria has a higher mortality rate and are secondary abdominal infections often polymicrobial?
What is the main difference seen in nosocomial infections?
What is the clinical presentation of SBP and when do you give paracentesis?
Gram negative. YES!!!
higher likelihood of drug resistance with more diverse array of pathogens. Abscesses contain bacteroides.
Temp(mild or not in PD), bowel sounds(hypoactive), cirrhotic patient(worsening encephalopathy), PD patient(cloudy dialysate fluid). Give before antibiotics.
Is a gram stain usually positive or negative in ascitic fluid from cirrhotic ascites?
What happens with temperature in secondary peritonitis?
How do you treat SBP?
Negative.
Normal and then increases to 100-102 within the first few hours and may continue to rise for the next several hours.
Augmentin or metronidazole with either cipro, levo or moxifloxacin. 4 days is sufficient.
Which bugs show resistance to clindamycin and cefotetan and what does to ampicillin sulbactam and quinolones?
What is empiric treatment of IAI with cirrhosis?
What is empiric treatment of IAI with peritoneal dialysis?
B.fragilis. Enterobacteraceae.
Ceftriaxone, Cefotaxime. Alternatives are Pip-tazo and carbapenems.
1st generation cephalosporin + aminoglycoside or Vancomycin + 3rd generation cephalosporin. Alternatives are Cefepime or Carbapenems may be used alone.
What is your preferred empiric treatment and what therapy has a favorable impact on patients?
When should patients begin to improve?
When is SBP prophylaxis indicated?
IV Cefotaxime. IV albumin adjunct therapy.
W/I 48 hours.
Cirrohitic ascites and previous case of SBP. Current GI bleed or albumin <1.5 + one other factor
What are your SBP prophylaxis options?
Why is gonorrhea so hard to treat and what is it’s clinical presentation in males?
How does gonorrhea present in females?
TMP/SMX or Daily PO Fluoroquinolone.
cases are unreported or diagnosed, asymptomatic, antibiotic resistance. Symptoms within 2-6 days most commonly mucopurulent penile discharge and dysuria. Women show a urethral infection.
Pelvic inflammatory disease in 15%, women show a urethral infection, disseminated gonorrhea 3 times more common.
What are diagnostic tests for gonorrhea and what is gonorrhea’s treatment?
How do you treat gonorrhea and a co infection?
What are your clinical pearls for gonorrhea?
NAAT’s, unable to provide resistance data but still solid. Single dose IM ceftriaxone 250 mg. If allergic to cephalosporins can give oral gemifloxacin or IM gentamicin.
Azithromycin as single dose is effective it is not recommend to ceftriaxone due to antibiotic resistance worry.
Also used to treat Chlamydia. Ceftriaxone can treat gonorrhea and syphilis, azithromycin can also treat trachomatis.
What is special about chlamydia and when should you start screening for it?
How does chlamydia present?
How do you treat chlamydia?
intracellular parasite that shares both bacterial and viral properties. Sexually active females <25, Sexually active women with new sex or multiple sex partners. NAAT diagnose test.
Milder than gonorrhea, urethral discharge is less profuse and more mucoid or watery. Causes severe PID if untreated(75%).
Normal. Azithromycin once or doxycycline for 7 days. Urogenital infections during pregnancy are Azithromycin as a single dose, amoxicillin 3 times daily for 7 days. Conjuctivitis in newborn or infants is erythromycin or ethylsuccinate.
What is helpful in viral shedding in genital herpes and what are some complications seen in herpes?
What is nonpharmacologic treatment of genital herpes?
What is herpes 1st infection treatment?
Acyclovir, Famciclovir, Valacyclovir. Happen commonly in primary 1st episodes and a major concern is the effect on neonates during pregnancy.
Pain and discomfort respond to warm saline baths, or the use of analgesics, antipyretics or antipruritics. Good genital hygiene.
Acyclovir 400 mg 3 times daily for 7-10 days. Acyclovir 200 mg 5 times daily for 7-10 days. Famciclovir 250 mg 3 times daily for 7-10 days or Valacyclovir 1 gram 2 times daily for 7-10 days.
How do you treat recurrent HSV infection?
How to treat HSV in chronic suppressive therapy?
How do you treat genital herpes in pregnancy?
Valacyclovir 500 twice daily for 3 days or valacyclovir 1 g once daily for 5 days. Famciclovir 125 BID x5, 1 g one day,500 mg once, 250 mg twice daily for 2 days. Acyclovir: 400 TID 5 days, 800 BID 5 days, 800 TID 2 days.
Acyclovir 400 mg BID or Famciclovir 250 BID or Valacyclovir 500 mg or 1 g orally once daily.
risk when mother acquires in 2nd half of pregnancy is 30-50%, women w/ current out break should deliver with c-section.
How do you treat trichominaisis?
How do you treat syphillis?
Metronidazole or Tinidazole avoid alcohol in 24 hours with metro and 72 with tini. 2 grams is common.
Parenteral penicillin.
