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Surgery M4 part 1 > Surgical infections > Flashcards

Surgical infections Flashcards

1
Q

When can we diagnose an infection as a surgical site infection?

A

any infection at surgical site up to 1 month after surgery

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2
Q

how many types of SSIs exist?

A 
Incisional
- superficial 
- deep 
Organ Space 
- generalized (peritonitis)
- abscess
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3
Q

Which surgeries are considered clean-contaminated surgeries?

A

cholecystectomy
appendectomy
elective bowel resection

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4
Q

hernia repair and breast biopsy are considered as which type of surgeries?

A

clean surgery

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5
Q

which surgery is a contaminated surgery?

A

Emergency bowel resection

emergency appendectomy

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6
Q

perforation or abscess require what type of surgery?

A

dirty/infected surgery

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7
Q

mention some host related risk factors for SSIs

A
  • diabetes
  • hypoxia
  • hypothermia
  • leukopenia
  • smoking
  • immunosuppression
  • malnutrition
  • poor skin hygiene
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8
Q

what are some surgical related risk factors for SSIs?

A
  • early operative site shaving
  • breaks in operative sterile techniques
  • improper antimicrobial prophylaxis
  • prolonged hypotension
  • contaminated operating room
  • poor wound care post-op
  • hyperglycemia
  • wound closure technique
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9
Q

How do we prevent the occurrence of SSIs?

A

PATIENT
- correct predisposing factor
- avoid elective surgeries in patients with active infections
TECHNICAL
- minimize pre-op stay
- shave or clip hair just before incision
- surgeon should scrub appropriately
- adequate hemostasis
- adequate drainage of infected wounds
ANTIBIOTIC
- selected according to suspected pathogen, tissue concentration, patient’s general condition
- single dose prophylactic antibiotic given 1 hour prior to surgical incision
- if surgery exceeds 2 hours another dose should be administered
- discontinue 24hrs after surgery in CLEAN surgeries

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10
Q

acute non-suppurative infection of loose connective tissue best describes what skin infection?

A

Cellulitis

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11
Q

What is the causative organism of cellulitis?

A

Steptococci

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12
Q

a patient presents to your clinic with a red, hot, indurated, and painful lesion. The lesion has ill-defined edges and she described that it spread rapidly. The patient had a fever and edema.
What is the diagnosis?

A

cellulitis

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13
Q

what occurs in a severe case of cellulitis?

A

patches of skin necrosis with sloughing of subcutaneous tissue

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14
Q

What are the complications of cellulitis?

A

may suppurate

may spread locally, through lymphatics, or hematogenously

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15
Q

How do we treat ANY non-suppurative inflammation?

A
  • antibiotic
  • analgesic and NSAID
  • rest & elevation of affected organ
  • hot fomentation
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16
Q

rapidly spreading non-suppurative inflammation of dermal lymphatics. What is your diagnosis?

A

Erysipelas

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17
Q

What is the causative agent of erysipelas?

A

Streptococci hemolyticus

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18
Q

How is erysipelas different from cellulitis?

A
  • the color of the skin is fiery red
  • the edge is well defined
  • islets of inflammation beyond the margins
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19
Q

What is the most important complication of erysipelas?

A

lymphedema

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20
Q

What are the suppurative inflammatory soft tissue infections?

A
  • boil (furuncle)
  • carbuncle
  • acute abscess
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21
Q

what is the definition of a boil?

A

Furuncle: acute suppurative inflammation of the sebaceous gland of the hair follicle

small painful indurated swelling which will eventually point and rupture

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22
Q

What is the causative agent of a furuncle, and who will it affect more?

A
  • staph. aureus

- in diabetics

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23
Q

Which soft tissue infection causes infective gangrene of the subcutaneous tissue?

A

Carbuncle (complicated furuncle): painful swelling with multiple sinuses discharging pus

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24
Q

the carbuncle is most common in who?

A

diabetics and immunosuppressed patients

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25
Q

What is the commonest location for a carbuncle to occur?

A

NAPE

back & gluteal region

26
Q

How does the infection usually start in a carbuncle?

A
  • infection starts in a hair follicle
  • then extends into subcutaneous fat where other hair follicles will get infected
  • multiple areas of necrosis and thrombosis of blood vessels occur
  • patches of skin undergo sloughing and separate from underlying granulation tissue
27
Q

What is the most important first-line treatment for a carbuncle?

A

CORRECT GENERAL CONDITION FIRST

and then surgical debridement of all necrotic tissue

28
Q

what is an acute abscess?

A

acute localized suppurative inflammation caused by the coagulase enzyme of staphylococci

29
Q

What are the manifestations of pus formation?

A
  • change of pain from dull to THROBBING
  • persistent fever becomes HECTIC
  • LOCALIZATION of inflammatory reaction
  • PITTING edema
  • fluctuation test becomes positive (dont wait for this)
  • shooting leukocytosis
30
Q

How should we drain an abscess?

A 
general anesthesia 
incision 
- adequate 
- dependent
- not crossing skin crease 
- parallel to important structures 
evacuation of all the pus 
open all loculi (either by finger or Hilton's method) 
pack for 24hrs (hemostasis & drainage)
(NEVER SUTURE AN ABSCESS)
31
Q

Which organism causes diffuse non-suppurative synergistic infection extending to the deep fascia causing its sloughing and necrosis

A

Synergistic (mainly group A streptococci) causes NECROTIZING FASCIITIS (flesh eating disease)

32
Q

What are the predisposing factors to necrotizing fasiitis?

A
  • following infected surgical procedure

- immunocompromised

33
Q

How does the infection spread in necrotizing fasciitis?

A

through subfacial planes
thrombosis of blood vessels
gangrene and sloughing of overlying tissue

34
Q

How should necrotizing fasciitis be treated?

A
  • MANDATORY adequate debridement
  • ICU to correct general condition
  • combined parenteral antibiotics
35
Q

How can we clinically diagnose necrotizing fasciitis?

A

sloughing & necrosis
offensive discharge
gangrene

36
Q

What is the difference between acute lymphangitis and lymphadenitis?

A

LYMPHANGITIS LYMPHADENITIS
- infection of lymph vessels - infection of lymph nodes
- red painful STREAKS - red hot swelling in usual
beneath skin sites of nodes (multiple)
- usually resolves - may resolve or suppurate
- treat as any non - treat as abscess if its
suppurative infection suppurative

37
Q

What is the difference between bacteremia and septicemia?

A

BACTEREMIA SEPTICEMIA
- non-multiplying bacteria - multiplying bacteria in
in blood blood

38
Q

What is the difference between toxemia and pyemia?

A

TOXEMIA PYEMIA

- bacterial toxins in blood - infected emboli in blood

39
Q

What are the specific acute infections?

A
  • tetanus

- gas gangrene

40
Q

Which organism is responsible for tetanus?

A

Clostridium tetani which is an anaerobic bacteria

41
Q

How does clostridium tetani invade tissue?

A
  • contamination of dead or ischemic tissue in wounds

- umbilical stump: tetanus neonatorum

42
Q

How does the clostridium affect the body?

A
  • exotoxin released in blood attaches to motor nerves
  • the toxin is irreversibly attached to the motor cells and anterior horn cells (cant be reversed by antitoxin)
  • toxin increases excitability of motor cells so slightest stimuli will cause a violet spasm
43
Q

What is the incubation period of clostridium tetani?

A

if non-immunized: 24hrs to 15 days

in immunized: several weeks or months

44
Q

What are the symptoms during the incubation period of clostridium tetani?

A
  • tenderness
  • rigidity of muscles
  • swelling at wound site
  • local twitches
  • restlessness and anxiety
45
Q

What are the 2 stages that occur in tetanus?

A

TONIC CLONIC

  • pain and tingling - violent muscular contractions
  • limitation in jaw movement - relaxation incomplete
  • spasm of facial muscles (isolate patient)
  • stiffness of neck
  • dysphagia
  • laryngospasm
  • opisthotonus
46
Q

What is the cause of death in a tetanus patient?

A

heart failure due to very high work load on heart due to continuous muscle contractions

47
Q

what are the general measures of prevention of tetanus?

A
  • avoid wound contamination
  • debridement of any necrotic tissue
  • irrigate wound with saline and H2O2
  • liberal drainage of any infected wound
48
Q

What are the specific measure of prevention of tetanus?

A

active immunization with tetanus toxoid with booster injection every 7-10 years

49
Q

How do we immunize an individual who received 3 or more doses the last 10 years?

A

booster dose of tetanus toxoid

50
Q

those who received less than 3 doses of tetanus immunization should receive?

A

booster dose of tetanus toxoid and tetanus immunoglobulin

51
Q

How do we immunize a patient who has not be previously immunized?

A

full immunization with tetanus toxoid and tetanus immunoglobulin

52
Q

how do we treat a patient with tetanus?

A

isolation in a quite place
neutralize toxin with TIG
wound debridement
muscle relaxant

53
Q

What other infection is caused by a clostridium bacteria BUT NOT clostridium tetani?

A

Gas gangrene only caused by contamination of wounds

54
Q

What is the pathogenesis of gas gangrene?

A 
wound infection 
spores germinate 
vegetative cells multiply 
carbohydrates fermentation (saccharolytic bacteria) 
gas production 
distention of tissues 
ischemia and gangrene (proteolytic bacteria)
toxemia and death
55
Q

What is the clinical picture of a patient that has a gas gangrene infection?

A
  • patient is toxic
  • offensive odor
  • crepitus
  • blackish discoloration
  • muscle doesnt bleed or contract when cut
56
Q

What is the immediate treatment of gas gangrene?

A

debridement of dead tissue

if gangrene is GROSS amputate

57
Q

how to treat a patient with a gas gangrene infection?

A
  • hospitalization and ISOLATION
  • support general condition
  • wound debridement or amputation if gross
  • massive parenternal antibiotics
  • hyperbaric oxygen
58
Q

What is a decubitus ulcers?

A

a pressure ulcer caused by avascular necrosis (bed sore)

localized tissue ischemia due to compression

59
Q

What are the stages of a bed sore?

A

Stage I: persistent redness
Stage II: partial thickness skin or tissue loss
Stage III: full thickness skin loss
Stage IV: full thickness tissue loss (exposed bone)

60
Q

How do we prevent a decubitus ulcer?

A
  • frequent change of position
  • air mattress
  • improvement of skin care and local hygiene

Surgery M4 part 1 (47 decks)

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