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?
Stones or sludge blocking neck of gall bladder leading to inflammation?
Gall stones is the most important cause
What are some symptoms and clinical signs of cholecystitis?
Pain in RUQ, tenderness (Murphy’s sign), Fever, Vomiting, peritonism,
Pain might be referred to right shoulder
Pain might be brought on by eating, particularly something fatty
What are some relevant investigations in cholecystitis?
High WCC
USS - thick walls of GB, might see stones, dilated CBD
LFTs - elevation of ALP, bili and ALT - only mild. If very high might suggest full obstruction of bile duct
ALP elevation suggestive of bile duct obstruction
What is the initial management of cholecystitis?
Keep them NBM
Give them opioid analgesics
give the IV fluids
Give them IV abx - consult trust guidelines ?Cefuroxime or tazocin
Management is surgical but often not emergency - wait for symptoms to settle
What is cholangitis?
This is all the features of cholecystitis PLUS jaundice - INFECTION IN GB.
What are the symptoms of cholangitis?
CHARCOT’S TRIAD
- RUQ pain
- Jaundice
- Fevers and Rigors
What increases the risk of cellulitis after a wound?
Retention of the foreign body Haematoma Devitalised tissue Poor nutrition and hence decreased immunity Diabetes
What is the most common organism to cause cellulitis?
Staph Aureus
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
