Exam 3 - Intraabdominal infections/C.Diff infections Flashcards
2 types of intraabdominal infections?
Peritonitis or abscess
definition of peritonitis
acute, inflammatory response of the PERITONEAL LINING in response to bacterial invasion, chemical irritation, irradiation, or foreign body injury
definition of abscess
- PURULENT collection of fluid separated from surrounding tissue by fibrinous capsule
- contains necrotic debris, bacteria, neutrophils
what part of the GI tract has a lot of anaerobes in their normal flora
colon
what is the etiology of secondary peritonitis
- results from a focal disease process within the abdomen
- bacteria usually enter the peritoneum as a result of disruption of the integrity of the GI tract by disease, injuries, surgery, or from local lesions of the female genital tract
Biliary tract or female genital tract:
has 0 normal flora?
has lots and lots normal flora?
biliary: 0
female genital: hella normal flora
in the STOMACH, bacterial counts increase up to 10^5-7 organisms/mL in what situations?
when LOW acid!
achlorhydria, H2 antagonists, PPIs, antacids, gastric cancer, gastric outlet
Super common bacterial species of intraabdominal infections?
E.Coli
Streptococcus
B.Fragilis/other bacteriodes
Clostridium
Intraabdominal infections have pseduomonas infections in what most situations?
in situations where the pt caught the infection in the hospital
Pathophys of intraabdomial infections:
NORMALLY peritoneal fluid is STERILE, ___ in protein and leukocytes, and contains no _______
LOW in protein/leukocytes
no fibrinogen
Pathophys of intraabdomial infections:
Serous fluid containing leukocytes/high protein concentration, and fibrinogen moves into peritoneum:
Fibrinogen polymerizes forming _____
adhesions (by forming plaques of fibrinous exudates on the inflamed peritoneal surface and begins to form adhesions)
What is “third spacing”
it is a fluid and protein shift – fluid moves to the peritoneal cavity
“Third spacing”: (decreased or increased)
_____ circulating blood volume
_____ cardiac output
_____ blood pressure
decreased
decreased
decreased…
Systemic GI responses to an intraabdominal infection?
initially diarrhea then bowel paralysis because of low perfusion –> distention b/c no poops
Systemic cardio responses to intraabdominal infections?
fluid going into peritoneal = decrease circulating blood volume/decrease venous return/decreased cardiac output/hypotension/
Systemic renal responses to intraabdominal infections?
decreased renal perfusion = acute renal failure
Systemic metabolic responses to intraabdominal infections?
increased energy demands deplete glycogen stores = catabolism of muscle/fat =weight loss
Role of facultative bacteria or anaerobes?
has virulence factors and are responsible for abscesses
anaerobes
Role of facultative bacteria or anaerobes?
produce extracellular enzymes to promote tissue invasion
and
provide environment conductive to growth for other bug
facultative
(these bugs use up the O2 which helps anaerobes grow)
(also they make enzymes to help anaerobes to get in)
Common symptoms of intraabdominal infections?
stomach pain (distension) Thirst (bc fluid in abdomen) Decreased urination (bc ^) cant pass gas/feces
Treatment of Secondary Peritonitis intraabdominal infections? (pharm and non-pharm)
collect cultures!! AEROBIC AND ANAEROBIC
empiric therapy to cover enterbacteriaceae and bacteriodes species
what two bugs are to cover empirically for Secondary Peritonitis intraabdominal infections?
enterbacteriaceae and bacteriodes species
what drugs typically cover anaerobes
we rarely have to do susceptibility testing for anaerobes
metronidazole
beta lactams + lactamase inhibitors
carbapenems
For intraabdominal infections: HEALTHCARE ASSOC.
want to have empiric therapy against _______ when..
[previous cephalosporin therapy,
pts who are immunocompromised,
if infection source is biliary tract,
pt has valvular hear disease or prosthetic intravascular material]
enterococci
