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Year 3 Infectious Diseases > Infection in surgery > Flashcards

Infection in surgery Flashcards

1
Q

Differentials

A 
UTI 
Prostatitis 
Pyelonephritis 
Ureteric colic 
STI 
BPH
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2
Q

Investigations

A

DRE
Abdo exam

Basic observations

Bedside:

  • Urine dipstick
  • Urine culture

Bloods:

  • FBC
  • CRP
  • U+Es
  • Pregnancy test

Imaging:

  • Bladder scan - retention
  • AXR - calculi
  • USS of kidneys - hydronephrosis
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3
Q

Acute bacterial prostatitis cause

A

Commonly occurs due to ascending urethral infection

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4
Q

Causative organisms of acute bacterial prostatitis

A

E. Coli
Enterobacteriaceae
Chlamydia
Gonorrhoea

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5
Q

Presentation of acute bacterial prostatitis cause

A

Prostate pain with LUTS

  • pain on ejaculation
  • lower back pain
  • perineal pain
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6
Q

Risk factors for acute bacterial prostatitis

A

Indwelling catheters

Phimosis or urethral stricture

Recent surgery, cystoscopy or transrectal prostate biopsy

Immunocompromised

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7
Q

Acute cystitis presentation

A

More common in women

LUTS and suprapubic pain

No perineal pain

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8
Q

Ureteric calculi presentation

A

Loin to groin pain

Pain in the penis or testes

Non visible haematuria

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9
Q

Bladder cancer presentations

A

LUTS

Painless haematuria

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10
Q

Mx of acute bacterial prostatitis

A

1st line: ciprofloxacin or trimethoprim

If systemically unwell - IV abx

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11
Q

When is specialist input required

A

DM patients
Prostate abscess
Long term catheters
Immunocompromised

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12
Q

Differentials for abdo pain following general surgery

A

Anastomotic leak
Adhesions - obstruction
Perforation

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13
Q

DRE post op

A

DRE should not be performed if suspected colonic anastomosis

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14
Q

Ix for post op abdo pain

A

Abdominal examination

Bloods

  • Group + save
  • ABG
  • CRP
  • Clotting

Imaging:

  • Erect CXR - perforation
  • CT AP with contrast
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15
Q

Anastomotic leak

A

Leak of luminal contents from a surgical join

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16
Q

Anastomotic leak presentation

A

Pt that is not progressing as expected

Or who deteriorates after surgery

5 - 7 days post op

17
Q

Risk factors for anastomotic leak

A

Medication - corticosteroids

Smoking

Diabetes

Alcohol

Obesity

18
Q

Management of anastomotic leak

A

NBM
Broad spectrum abx
Catheterise

< 5cm - IV abx

> 5 cm - percutaneous drainage

Septic - laparotomy and stoma

19
Q

What factors effect management of anastomotic leaks?

A
  1. Size of leak
  2. Extent of leak
  3. Physiological status of pt
20
Q

Post op surgical site pain differentials

A

Wound dehiscence

Chronic pain

Wound infection

21
Q

Presentation of Surgical site infection

A

Searing pain

Localised and worse on touch

Gradual onset and then constant

Pus or discharge

Wound dehiscence

5 - 7 days post op

Persistent pyrexia

22
Q

Ix for Post op surgical site pain

A

Abdominal examination

Check wound site

Swabs inside wound

Bloods

  • FBC
  • CRP

Blood culture if systemically unwell

23
Q

Common bacterial cause of wound infection

A

Staphylococcus aureus

24
Q

Risk factors for post operative surgical site infection

A

DM patients

Malnourished pts

Renal failure

Current smokers

25
Q

Post op fever causes

A
  1. Wind - pneumonia/ atelectasis
  2. Water - UTI/ IV line infection
  3. Wound
  4. Walk - VTE
  5. Wonder drugs
26
Q

Mx of surgical site infection

A

Conservative:

  • remove sutures or clips
  • allow wound drainage
  • pack wound if necessary
  • call senior

Pharmacological:
- Oral or IV flucloxacillin

  • If contraindicated - clarithromycin/ doxycycline
  • severe: oral co - amoxiclav or clindamycin
27
Q

MRSA mx

A

IV vancomycin

28
Q

How to prevent surgical site infections

A

Prophylactic abx

Remove hair immediately before surgery

Monitor wounds closely post op

Tissue viability nursing staff advice

29
Q

Osteomyelitis on Xray

A

Osteopenia
Periosteal thickening
Endosteal scalloping
Focal cortical bone loss

30
Q

Mx of osteomyelitis

A

IV flucloxacillin - 6 weeks

Consider rifampicin for initial 2 weeks

31
Q

Complications of osteomyelitis

A

Sepsis

Recurrent infections

Chronic osteomyelitis

Growth disturbance in children

32
Q

Differentials for osteomyelitis

A

Vertebral fracture
Osteoarthritis
Potts disease

Year 3 Infectious Diseases (15 decks)

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