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Infectious Disease > Week 4: Infections of the liver & biliary tree > Flashcards

Week 4: Infections of the liver & biliary tree Flashcards

1
Q

Case 1

A
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2
Q

Clinical findings of infections of the biliary system

A
  • Charcot’s triad (RUQ pain, fever and chills, jaundice) continuous pain may radiate to right infrascapular region
  • Murphy’s Sign: inhibition of inspiration by pain when the area of the gallbladder fossa is palpated
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3
Q

Laboratory findings of infections of the biliary system

A
  • Leukocytosis
  • Elevated alk phos & DB if the common bile duct is involved
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4
Q

Causative organisms of infections of the biliary system

A
  • GNR: E coli, Klebsiella
  • GPC: Enterococcus
  • Anaerobes also but not that common
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5
Q

Types of infections of the biliary system

A
  • Acute cholecystitis
  • Cholangitis
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6
Q

What is acute cholecystitis

A
  • obstruction of biliary drainage
  • up to 50% complicated by infection
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7
Q

Complications of acute cholecystitis

A
  • emphysematous cholecystitis
  • pyogenic liver abscess
  • bacteremia
  • perforation
  • peritonitis
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8
Q

What is cholangitis?

A
  • Infection of the common bile duct
  • stasis from obstruction favors the growth of bacteria
  • increased pressure predisposes bacteremia
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9
Q

Complications of cholangitis

A

may be associated with hypotension and altered mental status

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10
Q

Case 2

A
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11
Q

Routes of hepatic invasion causing pyogenic liver abscess

A
  • Cholangitis
  • Hepatic artery
  • Portal vein
  • Direct extension from contiguous focus of infection
    • cholecystitis
    • subphrenic abscess
    • perinephric abscess
  • Penetrating trauma
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12
Q

Common presentation of pyogenic liver abscess

A
  • middle-aged
  • 50% solitary
  • Right-sided
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13
Q

Diagnosis of pyogenic liver abscess

A
  • Fine needle aspiration for gram-stain and culture (aerobic & anaerobic)
  • Blood cultures (aerobic & anaerobic) positive 50%
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14
Q

Laboratory findings of pyogenic liver abscess

A
  • peripheral leukocytosis
  • elevated alk phos
  • Culture: polymicorbia;
    • GNR: E coli, Klebsiella
    • GPC: Enterococcus, Strep viridians group
    • Anaerobe: Bacteroides fragilis
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15
Q

Treatment of pyogenic liver abscess

A
  • Long-term antibiotics (4-6 weeks) PLUS drainage
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16
Q

Gram-positive cocci flowchart

A
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17
Q

gram-negative bacilli flowchart

A
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18
Q

Bacteroides fragilis type

A
  • Anaerobic GNR
  • GI flora
  • Major component of polymicrobial abdominal infections
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19
Q

Case 2 continued

A
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20
Q

Cause of amebic liver abscess

A
  • Ingestion of contaminated food/water with cysts of Entamoeba histolytica
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21
Q

Stages in human amebic liver abscess

A
  • Excystation in intestinal lumen
  • Trophozoites migrate to colon and adhere to epithelium
  • Trophozoites multiply by binary fission
  • Infectious cysts released in stool
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22
Q

Signs & Symptoms of Amebic Liver Abscess

A
  • 10% symptomatic colitis (DDx of bloody diarrhea)
  • <1% liver abscess
  • Entamoeba histolytica induces apoptosis in hepatocytes & neutrophils, forming large, non-purulent, “anchovy paste” abscesses
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23
Q

Diagnosis of Amebic Liver Abscess

A
  • imaging & serum Ab
  • Trichrome stain for cysts in stool not specific since look like nonpathogenic species
24
Q

Treatment of amebic liver abscess

A
25
Q

Case 3

A
26
Q

Hydatid cysts of liver

A
27
Q

Common presentation of Hydatid cysts of liver

A

many are asymptomatic

28
Q

Diagnosis of Hydatid cysts of liver

A
29
Q

Treatment of Hydatid cysts of liver

A
  • Surgical removal
    • Radical surgical resection
    • PAIR: puncture, aspiration, injection, re-aspiration
  • Albendazole x 30d
    • albendazole binds beta-tubulin of cestode
30
Q

Albendazole MOA

A
  • albendazole binds beta-tubulin of cestode
31
Q

Case 4

A
32
Q

What is Peritonitis?

A

Diffuse or localized infection in the abdominal cavity

33
Q

Signs & Symptoms of Peritonitis

A
  • Fever
  • Abdominal pain
  • Rebound
  • Guarding
34
Q

Types of peritonitis and prevalence

A

Primary (spontaneous) peritonitis 1%

Secondary 80-90%

35
Q

Risks for primary (spontaneous) peritonitis

A
  • cirrhosis with ascites (GNR)
  • Peritoneal dialysis (staph aureus, CoNS)
36
Q

Route for primary peritonitis

A
  • Hematogenous
  • lymphogenous
  • transmural migration through intact intestinal lumen
37
Q

Pathogen of primary peritonitis

A
  • Majority are monomicrobial
  • PMN >= 250 cells/mm3
38
Q

Secondary peritonitis cause

A

Intra-abdominal source

39
Q

Risks for Secondary peritonitis

A
  • bowel perforation
  • ischemic bowel
  • PID
40
Q

Secondary peritonitis pathogen

A

Majority are polymicrobial (GNR, Bacteroides fragilis, Enterococci, +/- Candida)

41
Q

What are intraperitoneal abscesses?

A
42
Q

Question

A
43
Q

Dx of viral hepatitis

A
44
Q

Question

A
45
Q

Question

A
46
Q

Case 4 continued

A
47
Q

Recommended testing sequence for identifying current HCV infection

A
48
Q

Question

A
49
Q

Question

A
50
Q

HBV serologies

A
51
Q

HBV antigens

A
52
Q

Viral hepatitis

A
53
Q

ABCs of hepatitis

A
54
Q

Antiparasitic agents

A
55
Q

Agents for the treatment of viral hepatitis

A

Infectious Disease (82 decks)

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