Sepsis

Question 1

What do you see on cytology with a sceptic abdomen?

Answer 1

degenerative neutrophils
Intracellular bacteria
Foreign material
Exudate~ highly cellular & high protein is consistent for sceptic peritonitis ( regardless of bacteria)

Question 2

What fluid analysis is indicative of a septic peritonitis?

Answer 2

Blood- abd. fluid glucose > 20 mg/dL (sensitive and specific)
Blood: fluid lactate >2 mmol/L (100% sensitive but can be produced from dead tissue)

Question 3

Septic peritonitis bloodwork?

Answer 3

Leukocytosis (left shift- indicates infectious process)
Renal/hepatic failure
Coagulopathy (low plt/ high D-dimer)–> DIC

Question 4

Septic pathophysiology?

Answer 4

Inflammation, hypotension–> organ failure

Question 5

Score: Sepsis

Answer 5

Abdominal infection: bacteria in abd. cavity (cytology/culture) OR pneumoperitoneum
- 90% survival

Question 6

Score: Severe sepsis

Answer 6

Sepsis + organ failure

- 50% survival

Question 7

Score: Septic Shock

Answer 7

Severe sepsis + requires pressors

• if no response in BP, then dont to surgery
• 10-20% survival

Question 8

What is the antibiotic triad used with sepsis?

Answer 8

“BAM”
Baytril, Ampicilin & Metronidazole
- make sure to give -cidal broad spectrum abx immediately, dont worry about specific
- Therapy: Fluids+ Abx+ SX (address source)

Question 9

What is the most common cause of sceptic peritoneum?

Answer 9

GI perforation

Question 10

How do you address a GI perforation (53-75%):

Answer 10

resection & anastomosis

Question 11

How do you address a biliary perforation?

Answer 11

caused by mucocele rupture; treat with chloecystectomy

Question 12

How do you address a abscess?

Answer 12

partial resection and omentalization ( put omentum in the hole which provides blood supply & drainage)