127 Intraabdominal Infection

Question 1

Occurs most commonly in conjunction with cirrhosis

Answer 1

SBP or primary bacterial peritonitis

Question 2

Diagnostic of SBP

Answer 2

Ascitic fluid finding of more than 250 PMN/uL

Question 3

Most encounter organism in SBP

Answer 3

E. Coli, Enteric gram negative bacilli

Question 4

Reasonable antibiotic coverage for SBP while awaiting for culture results

Answer 4

3rd generation cephalosporins: cefotaxime 2 grams q8hrs, Ceftriaxone

Question 5

divides the upper and lower peritoneal cavities

Answer 5

transverse mesocolon

Question 6

anterior retroperitoneal organs

Answer 6

pancreas, duodenum, ascending and descending colon

Question 7

posterior retroperitoneal organs

Answer 7

kidneys, ureters, adrenals

Question 8

occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism)

Answer 8

primary bacterial peritonitis (PBP)

Question 9

Diagnostic for Primary bacterial peritonitis

Answer 9

WBC more than 250 /hpf

Question 10

most commonly encountered organism in PBP

Answer 10

E. Coli

Question 11

antibiotics of PBP

Answer 11

cefotaxime 2 grams IV q8hrs, piperacillin tazobactam 4.5 grams IV q6hrs, ceftriaxone 2 grams IV q24hrs

Question 12

patients who may benefit from albumin infusion

Answer 12

Creatinine more than 1 mg/dl, BUN more than 30 mg/dl, T. Bilirubin more than 4 mg/dl

Question 13

how is albumin infusion done in patient with PBP

Answer 13

1.5 grams/KBW within 6 hours of detection then 1.0 grams/ KBW on day 3

Question 14

True or false. PBP has a high rate of recurrence of up 70% within 1 year

Answer 14

True.

Question 15

Secondary prevention of PBP

Answer 15

ciprofloxacin 750 mg weekly, norfloxacin 400 mg daily, TMP SMX 800/160 mg daily

Question 16

when does secondary peritonitis develop

Answer 16

when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus

Question 17

antibiotics of choice in secondary bacterial peritonitis

Answer 17

piperacillin tazobactam 4.5 grams IV q4-6 hrs, ceftriaxone 2 grams IV q24hrs + metronidazle 500 mg IV q8hrs, ICU: imipenem 500 mg IV q6hrs; meropenem 1 gram IV q8hrs

Question 18

common organism in continuous ambulatory peritoneal dialsysis associated peritonitis

Answer 18

skin organism; staph aureus

Question 19

most common reason for discontinuation of continuous ambulatory peritoneal dialysis

Answer 19

peritonitis

Question 20

antibiotic for CAPD Peritonitis and duration

Answer 20

MSSA: cefazolin, ceftazidime, flouroquinoline; MRSA: vancomycin + ceftazidime/cefepime/carbapenem; no exit/tunnel infection: 14 days; with exit/tunnel infection: 21 days

Question 21

infection in which viable infecting organism and PMN are contained in a fibrous capsule

Answer 21

abscess

Question 22

most prominent organism in abscess but only accounts for 0.5% of the normal flora

Answer 22

B. fragilis

Question 23

True or false. all intraabdominal abscess, 74% are intraperitoneal or retroperitoneal and not visceral

Answer 23

True.

Question 24

cause of intraperitoneal abscess

Answer 24

fecal spillage from a colonic source such as inflammed appendix

Question 25

True or false. Diverticular abscess are least likely to rupture

Answer 25

True.

Question 26

imaging modality with the highest yield for intraperitoneal abscess

Answer 26

abdominal CT scan

Question 27

imaging add on which can localized abscesses and useful in finding a collection

Answer 27

indium labeled WBC

Question 28

management of intraperitoneal abscess

Answer 28

antibiotics + percutaneous drainage

Question 29

organ most subject to abscess

Answer 29

liver

Question 30

most common presenting sign of liver abscess

Answer 30

fever

Question 31

mainstay therapy for intraabdominal abscesses

Answer 31

drainage

Question 32

treatment of candidal liver abscess

Answer 32

amphotericin B or liposomal amphotericin B with subsequent fluconazole therapy OR if susceptible, fluconazole 6 mg/kg/ day

Question 33

most common associated infection in splenic abscess

Answer 33

bacterial endocarditis

Question 34

most common bacterila isolates of splenic abscess

Answer 34

streptococcus

Question 35

standard treatment of splenic abscess

Answer 35

splenectomy with adjunctive antibiotics

Question 36

patient undergoing splenectomy should be vaccinated against what?

Answer 36

agains encapsulated bacteria such as Step pneumoniae, H. influenzae, N. Meningitidis

Question 37

True or false. Most renal or perinephritic abscess are from hematogenous spread

Answer 37

true.

Question 38

commonly recovered organism in renal abscess

Answer 38

E. Coli, Proteus, Klebsiella

Question 39

True or false. 75% of perinephric and renal abscesses arise from a urinary tract infection

Answer 39

True.

Question 40

important risk factor in perinephric abscess

Answer 40

concomitant nephrolithiasis

Question 41

treatment for renal or perinephric abscess

Answer 41

drainage and antibiotics

Question 42

how do psoas abscess arise

Answer 42

arise from hematogenous source , by continguous spread from an intraabdominal or pelvic process or by contiguous spread from nearby body structures

Question 43

When to suspect abscess in patients undergoing peritoneal dialysis

Answer 43

if peritoneal fluid culture is polymicrobial. Then do an abdominal CT scan.