intra-abdominal inf

Question 1

what is primary peritonitis? and who does it occur in?

Answer 1

peritonitis that occurs without an evident source.

Occurs in patients with ascites

Question 2

who gets acites? 6

Answer 2

Cirrhosis
Chronic active and acute viral hepatitis
Congestive heart failure
Metastatic malignant disease
Systemic lupus erythematosus
Lymphedema

Question 3

what is secondary peritonitis?

Answer 3

is usually caused by spillage of GI or genitourinary microorganisms into the peritoneal cavity owing to loss of the integrity of the mucosal barrier.

Question 4

what may cause spillage of GI or GU leading to secondary peritonitis? 6

Answer 4

Penetrating abdominal trauma
Ruptured appendix
Perforated peptic ulcer
Perforated diverticular disease
Perforated cholecystitis
Postsurgical complications following abdominal procedures

Question 5

what bug is the # 1 cause of Primary Bacterial Peritonitis? what about #2?

Answer 5

Enterobacteriaceae 63% (Escherichia coli, Klebsiella spp., etc.)
S. pneumoniae 15%

Question 6

what bug causes Secondary Bacterial Peritonitis

Answer 6

Often polymicrobial (Enterobacteriaceae, Bacteroides sp., enterococci, P. aeruginosa (3-15%))

Question 7

what are the most commonly isolated microorganisms in intraabdominal infections.

Answer 7

Escherichia coli (1) and Bacteroides (2)

Question 8

what are S&S of intraabd inf

Answer 8

Acute abdominal pain
Faint or absent bowel sounds
Fever
N/V
Elevated WBCs, BUN

Question 9

what does intraabd inf from perforation show on xray?

Answer 9

free air

Question 10

Empiric treatment of a patient diagnosed with primary peritonitis should include which of the following pathogen(s)?

Answer 10

enterobact, strep pneumo, enterococci, and bacteriodes (less than 1%) but still cover for

Question 11

what bact are associated with peritoneal dialysis?

Answer 11

Skin flora (S. epidermidis, S. aureus, Streptococci, Diphtheroids)

Question 12

what is the best empiric option for a patient diagnosed with primary peritonitis

Answer 12

Ampicillin 2 g IV Q4H + Gentamicin 5 mg/kg IV QDay + Metronidazole 500 mg PO Q8H

Question 13

what do you use for primary peritonitis if Extended Spectrum Beta Lactamase

Answer 13

imipenem or meropenem or ertapenem

Question 14

what is used in prevention of 1 peritonitis in cirrhosis and ascites?

Answer 14

TMP/SMX

Question 15

what is used for prevention of 1 peritonitis caused by cirrhosis and UGI bleed

Answer 15

cipro

Question 16

is empiric tx usually necessary for 2 peritonitis?

Answer 16

yes

Question 17

what is C.Diff

Answer 17

Anaerobic, Gram-positive spore-forming rod shaped bacteria

Question 18

what is Known cause of colitis and Pseudomembranous colitis

Answer 18

c.diff

Question 19

what are 4 risk factors for c.diff?

Answer 19

Antibiotic use (broad spectrum)
Manipulation of the GI tract (sgx, enemas, NG tubes)
Cytotoxic drugs
Age

Question 20

what is c.diff colitis? 3 steos

Answer 20

-Overgrowth of C. difficile
Normal flora
Newly acquired
-Toxin release
Toxin A: enterotoxin which is responsible for most symptoms – hemorrhage/fluid secretion
Toxin B: cytotoxin
-Ulceration caused by toxins released

Question 21

what are complications of c.diff colitis?

Answer 21

Toxic megacolon
Colonic perforation
Death

Question 22

what are symptoms of c.diff?

Answer 22

Typically > 5 loose stools per day over 2 days min
Cramping, abdominal pain, dehydration
Presence of systemic signs of infection
Fever, leukocytosis

Question 23

what is the characteristics of stool in c.diff

Answer 23

Watery, green, foul smelling, small volume, mucus or blood

Presence of stool leukocytes in 50% of patients

Question 24

how do you treat C.diff? 4

Answer 24

-Antibiotics
Metronidazole
Vancomycin
Bacitracin (Lack evidence, promising)
-Immunomodulation
Vaccine (decrease replapse)
IVIG
Hyperimmune bovine colostrum (prevent CDAD, relapse)
-Probiotics
Saccharomyces boulardii (prevents relapse,1 study)
-Surgery
Total colectomy (severe CDAD)

Question 25

what is adjuvant therapy for c.dif?

Answer 25

Prebiotic: oral oligofructose (increase bifidobacteria, decrease relapse)

fecal flora transplantation

Question 26

what does clindamycin treat?

Answer 26

Bacteroides Fragilis

Question 27

what does metronidazole treat?

Answer 27

Bacteroides Fragilis

Question 28

what does aminoglycosides treat?

Answer 28

E.coli

Question 29

what does aztreonam treat?

Answer 29

E.coli

Question 30

what does cipro treat?

Answer 30

E.coli

Question 31

what does cefoxtitin treat?

Answer 31

E.coli and bacteroides

Question 32

what does cefotetan treat

Answer 32

E.coli and bacteroides

Question 33

what does amp/sulbactam treat?

Answer 33

E.coli and bacteroides

Question 34

what does piperacillin/tazobactam treat?

Answer 34

E.coli and bacteroides

Question 35

what does ticarcillin/calvulanate treat?

Answer 35

E.coli and bacteroides

Question 36

what does imipenem treat?

Answer 36

E.coli and bacteroides

Question 37

what does meropenem treat?

Answer 37

E.coli and bacteroides

Question 38

what does ertapenem treat?

Answer 38

E.coli and bacteroides

Question 39

if in secodary peritonitis anaerobe is not isolated how do you treat?

Answer 39

still treat as if anaerobe was there

Question 40

what are choices of treatment of mild to moderate secondary peritonitis - inpt nonICU

Answer 40

ampicillin/sulbactam, piperacillin/tazo, ticarcillin/clavulnate, ertapenem, cefoxitin, cefotetan, cipro + metronidazole

Question 41

what are choices of treatment of mild to moderate secondary peritonitis - ICU pt

Answer 41

Imipenem, meropenem, amp + metronid + genta or tobra, amp+ metro + cipro