Infections Flashcards
What are some presenting features and signs of appendicitis?
Generalised abdominal pain that then localises to RIF as peritoneum becomes involved Profuse nausea and vomiting Anorexia Diarrhoea Guarding Rebound tenderness Fever Beware of signs of peritonitis or SHOCK if appendicitis's has ruptured
What would be some differentials for appendicitis?
Diverticulitis, Ectopic pregnancy, gastroenteritis, ovarian cyst
What makes appendicitis more difficult to diagnose?
Extremes of age and pregnancy
What investigations should you get in appendicitis?
FBC, U&E, LFT
- ESR, CRP and WCC will be raised
CT - highly sensitive and specific
USS - very commonly done
How should appendicitis be managed?
IV fluids Prophylactic Cef and Met Contact general surgery Slow IV metaclopramide Analgesia - opioid
What is cholecystitis?
What causes it?
- Inflammation of the gall bladder
- Caused by stones (most commonly) or sludge blocking neck of gall bladder
What are some symptoms and clinical signs of cholecystitis?
-RUQ pain
• may be referred to right shoulder
• may be worsened by eating, especially fatty
-Tenderness (murphy’s sign-palpation on inspiration=pain)
-Nausea and vomiting
-Fever
-May get signs of peritonism (guarding, rebound tenderness)
-May be able to feel a mass RUQ (inflamed surrounding bowel)
What are some relevant investigations in cholecystitis and results?
Cholecystitis Bedside -obs and exam Bloods -FBC (high WCC) -LFTS (elevation of ALP, bili and ALT - only mild. If very high might suggest full obstruction of bile duct)
Imaging
-USS - thick walls of GB, might see stones, dilated CBD
What is the initial management of cholecystitis?
Cholecystitis management
Conservative
-Keep them NBM
-IV fluids
Medical
- IV opioid analgesics
- IV Antibiotics (guidelines)
Surgical
-Surgical management (laparoscopic cholecystectomy, normally can wait for symptoms to settle)
(if perf-open surgery)
What is cholangitis?
- Infection of the bile duct
- This is all the features of cholecystitis PLUS jaundice - INFECTION IN GB.
What are the symptoms of cholangitis?
How do you treat this?
CHARCOT’S TRIAD
- RUQ pain
- Jaundice
- Fevers/Rigors
Piperacillin and tazobactam
How do you manage cholangitis?
Cholangitis managment
-ABCDE management (including blood cultures, IV fluids)
Conservative
- NBM and NG tube if vomiting
- Close observation-be aware of sepsis ( to determine the need for emergency decompression of the biliary tree
Medical
-Empirical IV antibiotics depending on blood cultures
Surgical
if medical therapy doesn’t work, they will need surgery (emergency decompression of the biliary tree)
What is the most common organism to cause cellulitis?What increases the risk of cellulitis after a wound?
Staph Aureus is the most common cause
Risk factors of cellulitis following a wound:
- Retention of the foreign body
- Haematoma
- Devitalised tissue
- Poor nutrition and hence decreased immunity
- Diabetes
What is the initial management for cellulitis and when should you consider admission?
Consider admission if patient is >38C, systemically unwell, regional lymphadenopathy or cellulitis is widespread
Consider - fluclox, BenPen or co-amox
Monitor vital signs for developing sepsis
What score do we use to grade croup?
Westley croup score:
STRIDOR: none=0, when agitated=1, at rest=2
RECESSIONS: mild=1, moderate=2, severe=3
AIR ENTRY: Normal=0, mild decrease=1, marked decrease=2
SpO2<92% on air: Non=0, with agitation=4, at rest=5
Level of consciousness: Normal =0, reduced=5
MODERATE = 3-5, SEVERE 6-11, IMPENDING RESP FAILURE >11
