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Transition Block 1 > Intra-abdominal Infection > Flashcards

Intra-abdominal Infection Flashcards

1
Q

colonisation definition?

A

presence of microbe in human without inflammatory response (there but not causing issue)

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2
Q

infection?

A

inflammation due to a microbe

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3
Q

bacteraemia?

A

presence of viable bacteria in blood

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4
Q

sepsis?

A

systemic inflammatory response to infection

life-threatening organ dysfunction caused by a dysregulated host response to infection

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5
Q

septic shock?

A

subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality

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6
Q

what can cause an infection to become problematic?

A

unusual host response (age, immunosuppression, co-morbidity, drugs etc)
unusual microbe response (virulence expression latency, intracellular predilection for certain sites)
site of infection (worse if deep seated infection - cardio, bone, joints, occult)

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7
Q

where can defence defects occur in the host?

A 
surface mucosal barrier
complement
antibodies
B cells
macrophages
cytokines
T cells
NK cells
(area of defect depends on illness - eg alcoholism, malnutrition etc)
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8
Q

what do phagocytes target?

A

bacteria

fungi

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9
Q

what do T cells target?

A

viruses
fungi
protozoa

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10
Q

what do B cells and antibodies target?

A

bacteria

viruses

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11
Q

what do eosinophils target?

A

fungi
protozoa
worms

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12
Q

what di mast cells target?

A

worms

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13
Q

what does complement target?

A

bacteria

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14
Q

what organisms are usually found in peritoneal cavity?

A

none
should be sterile
leakage of bowel contents etc results in peritonitis

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15
Q

what can cause leakage of bowel contents?

A

perforated duodenal ulcer
perforated appendix
perforated diverticular
perforated tumour

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16
Q

what is SOFA score?

A 
sequential organ function assessment 
(sepsis related)
takes into account
- resp
- coagulation
- liver function
- cardio
- CNS
- renal
each scored from 0-4 (0=best, 4=worst)
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17
Q

qSOFA?

A 
shortened SOFA scoring
screens for outcome (not diagnosis)
- RR>22
- systolic BP < 100
- altered GCS
0/3 = <1% mortality
1/3 = 2-3% mortality
2+/3 = >10% mortality
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18
Q

SIRS criteria?

A

when 2 or more of the following are present

  • temp >38 or <36
  • HR > 90
  • RR >20 or PaCO2 < 32 (4.3kPa)
  • WCC > 12000 (>12x10^9/L)
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19
Q

how does infection severity progress?

A

colonisation > infection > SIRS > sepsis > severe sepsis > septic shock
(mortality increases)

20
Q

what is SIRS?

A

systemic inflammatory response syndrome
whole body inflammatory response
non-specific clinical response including >2 of the following
- temp >38 or <36
- HR >90
- RR >20
- WCC >12000 or <4000 or >10% immature neutrophils

21
Q

what can cause SIRS?

A 
infection
trauma
burns
pancreatitis
other insults
22
Q

how is sepsis different to SIRS?

A

sepsis = SIRS with a presumed or confirmed infectious process

23
Q

what is septic shock?

A

sepsis + signs of at least 1 acute organ dysfunction

24
Q

what organisms generally cause community infection?

A 
E coli (urine, abdomen)
strep pneumoniae (resp)
staph aureus (usually MSSA - skin)
25
Q

what organisms generally cause hospital infection?

A 
E coli (catheter or abdomen)
staph aureus (usually MRSA - line or wound related)
CNS (line/prosthesis related)
enterococci (urine, wound, line)
klebsiella (urine, wound)
pseudomonas
26
Q

supportive management in infection syndrome?

A 
fluids
analgesia
VTE prophylaxis
oxygen
control electrolyte balance
need for transfusion
27
Q

when might surgery be needed to support infection?

A

exploration

incision-excision and drainage etc

28
Q

what are coliforms?

A

E coli and similar bugs that inhibit large bowel
e.g klebsiella, proteus, Enterobacter, serratia etc
rod shaped gram -ve bacteria

29
Q

example of strict aerobe?

A

pseudomonas

30
Q

examples of aerobes?

A

staph
strep
enterococci
coliforms (majority of human pathogens)

31
Q

examples of strict anaerobes?

A

clostridium
bacteroides
anaerobic cocci
(Present in large numbers in large bowel)

32
Q

normal mouth flora?

A 
strep viridans
Neisseria (gram -ve cocci)
anaerobes
candida (few)
staph
33
Q

normal stomach/duodenum flora?

A

usually sterile

can have a few candida and staph which may survive acidic environment

34
Q

normal flora of jejunum?

A

small numbers of coliforms and anaerobes

35
Q

normal flora of colon (faecal flora)?

A

large numbers of coliforms, anaerobes and enterococcus faecalis

36
Q

normal flora of bile ducts?

A

sterile

37
Q

how long are antibiotics given in sepsis?

A

usually 10-14 days

4-6 weeks if complicated

38
Q

empirical treatment of intra-abdominal infections?

A

amoxicillin + gentamicin + metronidazole
amox = strep and enterococcus
gent = aerobic coliforms
met = anaerobes

39
Q

how are abscesses managed?

A

large abscess has no blood supply so antibiotic wont reach it
small abscesses can be treated with antibiotics but large ones need incision and drainage

40
Q

antibiotic for coliforms?

A

gentamicin

41
Q

antibiotics for anaerobes?

A

metronidazole

42
Q

antibiotic for enterococcus?

A

amoxicillin

43
Q

intra-abdominal infection empirical management if penicillin allergic?

A

cotrimoxazole + gentamicin + metronidaole

44
Q

what antibiotics are used for prophylaxis in GI/hepatobiliary surgery?

A

gentamicin + metronidazole

45
Q

what is the risk with gentamicin?

A

renal damage (nephrotoxic)

46
Q

how is nephrotoxicity risk managed in gentamicin use?

A

limit duration to 72 hrs after which ID/micro approval is needed
limit duration to 24 hrs if concerns of renal function
monitor renal function daily
clear exclusion criteria also exists
check levels twice a day

47
Q

dosing in gentamicin?

A

dose per weight?
ensure correct dosing in overweight patients
max dose = 600mg

Transition Block 1 (14 decks)

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