133b Intraabdominal infections

Question 1

typhalitis
cause?
outcome?

Answer 1

chemo injures mucosa + neutropenia –> microbial invasion of bowel wall and necrosis

high mortality

Question 2

primary peritonitis (aka spontaneous bacterial peritonitis)
cause?
spread?
presentation?
dx?

Answer 2

cirrhosis and ascites –> bacterial peritonitis without inciting event

spread from blood, lymph, vagina

presentation - worse encephalopathy

dx - >250 neutrophile on paracentesis

Question 3

secondary peritonitis - cause?

Answer 3

bowel contents spill into cavity

Question 4

diagnosis of SBP

Answer 4

paracentesis >250 PMNs

only 1 bacteria

Question 5

secondary paritonitis - pathogenesis and number of organisms?

Answer 5

spillage of gut bugs into cavity + other things (bile, gastric juice, etc)

multiple organisms (unlike SBP)

Question 6

etiology of SBP

Answer 6

E Coli
Klebsiella
Steptococcus pneumoniae

Question 7

where is highest concentration of bacteria and risk for secondary peritnonits?

Answer 7

colon

Question 8

secondary peritonitis clincal presentation?

Answer 8

lies with knees flexed
rebound tenderness
ab wall rigidity

WBC w/ left shift

different than SBP with low WBCs –> not much of a reaction

Question 9

visceral abscess

Answer 9

from underlying organ injury

blood spread for monomicrobial

communication with bowel lumen for polymicrobes

Question 10

Secondary peritonits dx

Answer 10

high WBC with left shift

ileus on xray

free air in chest xray

Question 11

sec perit rx

Answer 11

broad antibiotics

surgery

drainage

Question 12

CAPD Peritonitis - pathogensis

Answer 12

from catheter – biofilms

staph epidermidis/aureus

Rx - antibiotics via dialysate

preventation - sterile technique and topical antibiotics to catheter

Question 13

intraperitoneal abscess - what is it? what organism causes it? symptoms?

Answer 13

fibrous capsule contains infectious organisms w/ PMNs; prevents spread

Bacteroides fragilis + polymicrobial

fevers, chills, pain, tenderness over area

Question 14

splenic abscess

Answer 14

always blood spread - infective endocarditis

untreated - 100% death

Question 15

diverticulitis

Answer 15

perforation of herninations of mucosa through muscalaris layer - sigmoid and descending colon

resembles acute appendicitis but on left side

Question 16

A patient with alcoholic cirrhosis, portal hypertension presents with hepatic encephalopathy and tense ascites.Which test is most likely to diagnose spontaneous bacterial peritonitis (SBP)?

Answer 16

Peritoneal fluid neutrophil count

Question 17

A 52 yo male previously healthy presents with abdominal pain, nausea, vomiting and fever. On abdominal exam, you identify RLQ tenderness, guarding and rebound.Which of the following is the likely diagnosis?

Answer 17

Acute perforated appendicitis

Question 18

CT scan confirms acute appendicitis, perforation and peri-appendiceal abscess. Empiric antibiotic therapy should be directed against which microorganisms?

Answer 18

Aerobic gram negative bacilli and anaerobes