9 - Purple Flashcards
What type of bacteria is C.diff
G-pos bacilli
Spore -forming
Anaerobic
What antibiotics cause C.diff
Clindamycin
Ampicillin
Cephalosporins
What is the treatment for C.diff
Oral flagyl
Oral vancomycin
What are the risk factors/causes for fistula formation
FRIEND Foreign body Radiation Infection Epitheliazation Neoplasia Distal Obstruction
What happens metabolically from a fistula
Metabolic acidosis + loss of HCO3
OR
NAGMA + retention of Cl-
What are some significant causes of HCO3 loss
Diarrhea
Small bowel fistula
Uterosigmoidoscopy
What can result if you replace EVF with HCO3 free solutions
May cause dilutional acidosis associated with normal anion gap
What fistulas are more likely to close on their own
Esophagus, duodenum, jejunum
VS stomach, ligament of treitz or lieum
What are specific characteristics of the bowel that are associated with likelihood of requiring surgery
Bowel discontinuity Severely diseased adjacent bowel Large adjacent abscess Opening in the bowel over 1cm2 Short fistula tract - under 2cm from skin Foreign body Prev adjacent radiation therapy Associated IBD
What is the management for a fistula
Broad spectrum abx
Drainage of abscess
Hyperalimentaion (TPN)
Somatostatin (octreotide) - antiperistaltic, inhibits VIP, GH, LH, insulin and glucose
What is the timeline for normal return of gut function post-operatively
SB - almost immediately
Gastric function - 2-3 days
Colon function 3-5 days
What is the neurogenic etiology of an ileus
Spinal cord lesion
RP process, hematoma or tumour
Ureteral colic
What is the metabolic etiology of an ileus
HypoK+ Ca2+ , Mg2+ imbalance Uraemia Hypothyroidism Diabetic coma or DKA
What is the pharmacology etiology of an ileus
Anticholinergics narcotics Autonomic blockers CCB Antihistamines Psychotropics Phenothaizines Haloperidol Tricyclics Clonidine Vincristine
What is the infectious etiology of an ileus
Sepsis Pneumonia Peritonitis Herpes zoster Tetanus Bacterial overgrowth of bowel
