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Gastroenterology exam 2 > GI expressions of infectious disease II > Flashcards

GI expressions of infectious disease II Flashcards

1
Q

What is Primary Bacterial Peritonitis (PBP)? and what is the most common bacteria?

A

Fever, peritoneal irritation, >250 PMNs/uL in fluid

most common: Escherichia coli

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2
Q

What some causes of PBP?

A
  1. No apparent source of contamination (spontaneous)

2. Cirrhosis, ascites (liver fails to filter intestinal bacteria in portal blood)

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3
Q

What is the Tx of PBP?

A

start with: broad spectrum Abx covering both Gram - aerobic and Gram +

  1. 3rd gen cephalosporin
  2. prevent recurrence w Abx prophylaxis (fluoquinolones or sulfa)
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4
Q

What causes Secondary peritonitis due to perforation? What is the most common organism?

A

Mixed: Gram - facultative bacilli and anaerobes
endotoxin is produced from gram (-) = fever, shock, DIC
most common anaerobe = BACTEROIDES FRAGILIS
most common facultative = ECOLI

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5
Q

What are Sx of secondary Peritonitis due to Perforation

A

Sharp pain
Guarding, tenderness, rebound pain
Fever and leukocytosis

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6
Q

What is Tx for secondary Peritonitis due to Perforation? (mild/moderate, severe)

A

mild/moderate: broad-spectrum penicillin/clavulanate, 3rd gen cephalosporin, fluoroquinolone, w Metronidazole

Severe: carbapenem or combo
Surgery often needed

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7
Q

What is an abscess?

A

infection in which viable organisms and PMNs are contained in a fibrous capsule

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8
Q

What is so special about Bacteroides fragilis? what does it need to have successful infection?

A 
Number one anaerobic isolate:
1. in intra-abdominal infections
2. in abdominal abscesses
3. isolated from blood
needs a Facultative partner
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9
Q

Where are abscess usually found (when standing and laying down)

A

standing: pelvic cavity

laying down: Morrison’s pouch

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10
Q

What are way to identify abscess formation (3 ways)

A
  1. CT and sonographic scanning
  2. Gallium and indium labeled WBCs
  3. Barium enema - for unperforated abscess
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11
Q

What are four sources of infection for Liver abscess?

A
  1. seeding from peritonitis (ruptured appendix)
  2. infx of biliary tract (through ampulla)
  3. via portal vein
  4. Hematogenous (hepatic artery)
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12
Q

What are the common organisms associated with each source in Liver abscesses?

  1. Biliary
  2. Peritoneal
  3. Hematogenous
  4. Chemotherapy
  5. Portal
A
  1. Enterobacteriaceae, Enterococci
  2. mixed, w/ B. fragilis
  3. S. aureus or Streptococci
  4. C. albicans
  5. Entamoeba histolytica
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13
Q

What are clinical Sx of Liver Abscess?

A
  1. Fever (sometimes only Sx)
  2. RUQ pain
  3. Hepatomegaly, Jaundice
  4. Weightloss, nausea, vomiting
  5. elevated ALP, Aminotransferases (hepatocyte damage)
  6. Leukocytosis + anemia
  7. Bacteremia
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14
Q

What are 2 ways to identify Entamoeba histolytica?

A
  1. find cysts in feces

2. Ags (if in liver)

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15
Q

What is the Tx for liver abscesses (Candida, Amoeba)

A 
drainage
Candida: Amphotericin B
Amoeba:
1. tissue trophozoites: Metronidazole
2. luminal cysts: Paromomycin
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16
Q

What is Necrotizing Fasciitis (NF)? When does it usually occur? and what are Sx?

A

Rapidly progressive infx of deep fascia w NECROSIS of subcutaneous tissue

occurs: after surgery or trauma

Sx: Erythema + pain disproportionate to physical findings

17
Q

What is necrotizing fasciitis called in the perineal region?

A

Fournier gangrene

18
Q

What are the causal organisms of Type I Necrotizing Fasciitis?

A

Average of 5 organisms per wound
Gram (-): Enterobacter, Bacteroides
Gram (+): Non-group A Strep, Clostridium, Peptostrep
Marine vibrios, (Vibrio vulnificus = salt water NF)

19
Q

What causes Type II Necrotizing Fasciitis?

A

Streptococcus Pyogenes (combo w S. aureus, MRSA)

S. pyogenes produces TSST (toxic shock syndrome toxin) = stims production of TNF + cytokines

20
Q

What are risk factors for Type I Necrotizing Fasciitis?

A 
DM
severe PVD
Obesity
Alcoholism
IV drugs
Bed sores (ulcers)
penetrating trauma
Abscess of female genital tract
21
Q

What are risk factors for Type II Necrotizing Fasciitis?

A 
DM
severe PVD
Recent Parturition (giving birth)
Trauma
VARICELLA
22
Q

What are clinical Sx of Necrotizing Fasciitis?

A

RAPID prog:
erythema - bullae - ecchymosis - necrosis - gangrene

Skin: blue/black discoloration
edematous, WOODEN feel of subcutaneous tissue
High fevers
intense PAIN OUT OF PROPORTION to findings
Crepitus - gas in soft tissues
Infarct nerves = cutaneous anesthesia

23
Q

What is cellulitis?

A

infection of skin and subcutaneous fat

24
Q

What is Tx for Necrotizing Fasciitis?

A 
Surgical Debridement
Broad spectrum Abx
Vancomycin - MRSA
Metronidazole - Gram neg anaerobes
Hyperbaric oxygen - anaerobes

Gastroenterology exam 2 (19 decks)

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