Intrabdominal infections Flashcards Preview

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Flashcards in Intrabdominal infections Deck (48):
1

define intrandominal infection

presence of micro-organism in normally sterile sites within the abdominal cavity e.g. peritoneal cavity and hepatobillary tree.

2

why is gastroenteritis not classed as a intrabdominal infection

bowel lumen is not sterile

3

which areas of the stomach and small intestine are sterile

stomach
proximal small intestines- bile and acid from stomach kill all pathogens.

4

what is the normal amount of flora in the large intestine ? 10 ^

10^9-11

5

what pathogens mainly occupy the large intestine flora

anaerobic bacteria (95-99%)

6

3 main sources of intrabdominal organs

GI contents, blood, external

7

defien intrapertioneal.

• Translocation of micro- organisms from gastrointestinal tract lumen to peritoneal cavity

8

define billary tract infection

• Translocation of micro-organism along a lumen- up to liver

9

define haematogenous spread

• Translocation of micro-organism from a extra-intestinal source- penetrating trauma

10

how can traslocation of an organism across a wall occur

• Perforation-Perforated appendix, perforated ulcer, perforated diverticulum, malignancy
• Loss of integrity- Ischemia, strangulation (herniation of bowel)
• Surgery- Seeding at operation, anastomotic leak (as it is incomplete or it has broken down).

11

how can traslocation of an organism along a lumen occur

• Blockage- Cholecystitis, cholangitis, hepatic abscess
– Gall bladder is not normally sterile but bile keeps it sterile, so blockage will mean that no bile can pass so organisms can harbour
• Iatrogenic- Instrumentation (e.g. ERCP)- endoscopic retrograde cholangio pancreatography.

12

causes of obstruction of lumen of vermiform appendix.
(example of translocation across a wall- appendicitis)

– Lymphoid hyperplasia, faecal obstruction, stagnation of luminal contents, bacterial growth and recruitment of inflammatory cells.
– Build up of intraluminal pressure may result in perforation
– Escape of luminal contents into peritoneal cavity is “peritonitis”

13

symptoms of appendicitis

temperature, severe generalised pain.

14

treat for appendicitis

appendicecectomy and cefuroxime, and metronidazole for 5 days.

15

what form of intra abdominal infection is appendicitis

translocation across wall

16

what form of intraabdominal infection is perforated diverticula

translocation across wall

17

define perforated diverticulum

• Herniation of mucosa and sub mucosa through muscular layer

18

common complication of bowel cancer

Intraperitoneal and/or bloodstream infection

19

what organism cause Intraperitoneal and/or bloodstream infection in bowel cancer

clostridium septicum and streptococcus gallolyticus

20

symptoms of bowel cancer

weight loss, alteration of bowel habits, and blood in stool.

21

what causes ischaemia of the bowel

– Strangulation
– Arterial occlusion
– Post operative
– E.g. Aneurysm repairs.

• Interruption of intestinal blood supply

22

how does ischaemia result in translocation of lumina contents

lack of blood supply results in gut wall loses structurally and integrity

23

causes of post operative infections

• Seeding at operation
– Incidence is reduced due to bowel preparation with prophylactic antibiotics- prior to surgery.
• Anastomotic leak- due to breakdown or due to non formed anastomosis
• Acute infection- abdominal pain and tenderness, shock
• Intraperitoneal abscess- walled off abscess, more indolent condition (presents some weeks after surgery).

24

define cholecystitis

inflammation of the gall bladder

25

symptoms of cholecystitis

fever, right upper quadrant pain, mild jaundice.

26

clinical presentation of empyema in the gallbladder

severe pain, High fever, Chills and rigors.

27

empyema of the gallbladder is a complication of what condition

cholecystitis

28

define cholangitis

• Inflammation/infection of biliary tree

29

causes of cholecystisis and cholangitis

– Mainly obstruction of common bile duct
– Can follow instrumentation (e.g. endoscopic retrograde cholangio-pancreatography, ERCP)

30

symptoms of cholangitis

– Fever (rigors), jaundice and right upper quadrant pain

31

define pyogenic liver abcesss

collection of pus in liver.

32

routes for infection which causes pyogenic liver abcesses

biliary obstruction, direct from intrabdominal infections, Haematogenous- from mesenteric infections via hepatic portal vein, from systemic intravascular infection- hepatic artery

33

predisposing factors to intrarittoneal abcessess

– Perforation-Peptic ulcer, Perforated appendix, Perforated diverticulum
– Cholecystitis
– Mesenteric ischemia/bowel infarction
– Pancreatitis/pancreatic necrosis
– Penetrating trauma
– Postoperative anastomotic leak

34

common areas for intraperitoneal abcess to form

– Subphrenic, subhepatic, paracolic, pelvic

35

symptoms of intrapertioneal abcess

non specific
Sweating, anorexia, wasting, High swinging pyrexia (high then low)

36

symptoms of subphrenic abcess

– Pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly (liver displaced downwards, ipsilateral lung collapse with pleural effusion (collapse where ulcer is and effusion is due to blood)

37

symptoms of a pelvic abcess

– Urinary frequency
– Tenesmus- need to release bowels.

38

common aerobic bacteria gram -ve bacilli

E .coli

39

common anaerobic bacteria gram -ve bacilli

Bacteroides

40

common aerobic Gram-positive cocci

Enterococcus spp.
Occasionally milleri-group streptococci

41

common anaerobic Gram-positive bacilli

clostrisium

42

common features of liver abscesses.

polymicrobial

43

what can cause a liver abcess

haematogenous spread or trauma may not involve normal GI flora
Hepatobiliary tract infections usually involve lower GI flora, despite

44

what blood investigations are carried out for intraabdominal infections

• Full blood count: neutrophilia/neutropenia
• C-reactive protein: raised
• Liver function tests: abnormal in hepatobiliary disease

45

what is imaging used for intraabdominal infections and why is it used

Chest x-ray
– Consolidation, pleural effusion adjacent to infected area (e.g. subphrenic abscess)
Abdominal ultrasound
– Abdominal masses
– Free fluid
– Dilated bile ducts
Abdominal CT scan
– Higher definition than ultrasound

46

what microbiological investigations (excluding bloods) are carried out for intraabdominal infections

– Peritoneal fluid
– Ultrasound/CT guided drainage fluid
– Microscopy, culture and sensitivity testing

47

most common treatment for Intraperitoneal abcess

drainage

48

how are antibiotics used to treat intrabdominal abcesses

• Start smart ….
– best guess(empirical) antibiotics.
– Intestinal source- coliforms and anaerobes.
o Cefuroxime & metronidazole (