Intra - abdominal Infection and Sepsis Intro

Question 1

Define Colonisation

Answer 1

The presence of a microbe in a body without inflammatory response

Question 2

Define Infection

Answer 2

Inflammation due to a microbe

Question 3

Define bacteraemia

Answer 3

The presence of viable bacteria in the blood

Question 4

Define sepsis

Answer 4

The systemic inflammatory response to infection

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 5

What is septic shock

Answer 5

Subset of sepsis with an increased risk of mortality

Question 6

What causes an unusual host response

Answer 6

Age
Immunosuppressed
Co-morbidity
Genetics

Question 7

What causes peritonitis

Answer 7

Leakage of bowel contents results in peritonitis - peritoneal cavity cavity normally sterile

Question 8

Local S+S of infection

Answer 8

Pain
tenderness
guarding
blood PR

Question 9

Systemic S+S of infection

Answer 9

Fever
Chills or rigors
Nausea and Vomiting
Constipation or diarrhoea
Malaise anorexia

Question 10

qSOFA

Answer 10

RR>22bpm
sBP <100mmHg
Altered GCS

0=mortality <1%
1 = mortality 2-3%
>/ = mortality >/10%

Question 11

What does the aSOFA screen for

Answer 11

Mortality risk as opposed to cause

Question 12

What is the cause of E.coli bacteraemia in the community

Answer 12

Urine, abdomen

Question 13

What is the cause of E.coli bacteraemia in the hispital

Answer 13

Catheter related or abdomen

Question 14

What is a coliform

Answer 14

E. coli and other organisms that inhabit the large bowel

Question 15

What is a strict aerobe

Answer 15

Organisms that require oxygen for growth pseudomonas sp

Question 16

What is an aerorbes organism

Answer 16

One that grows best in oxygen but can also grow without it - e.g. staph, strep, enterococci, coliforms

Question 17

Strict anerobes

Answer 17

Organisms that will not survive in oxygen - e.g. clostridium, bacteroides, anaerobic cocci

Question 18

Normal flora of the mouth

Answer 18

Strep viridans
Nissiera
Anaerobes
Few Candida
Staph

Question 19

Stomach normal flora

Answer 19

Normall sterile

Few staph and candida may survive

Question 20

Jejunum normal flora

Answer 20

Small numbers of coliforms and anaerobes

Question 21

Colon normal flora

Answer 21

Large no. of coliforms, anaerobes, enterococcus faecalis

Question 22

Bile ducts normal flora

Answer 22

usually sterile

Question 23

What is used to treat streptococci and enterococci

Answer 23

amoxicillin

Question 24

What is used to treat aerobic coliforms

Answer 24

Gentamicin

Question 25

What is used to treat anaerobes

Answer 25

Metronidazole

Question 26

How can a small abscess be treated

Answer 26

Antibiotics

Question 27

How is a large abscess treated

Answer 27

Incision and drainage

Question 28

What is the treatment of intra - abdominal sepsis

Answer 28

Gentamicin, metronidazole, amoxicillin

Question 29

What is the treatment if intra abdominal sepsis if you are penicillin allergic

Answer 29

Gentamicin, metronidazole, co trimoxazole

Question 30

Prophylactic GI treatment

Answer 30

Gentamicin and metronidazole

Question 31

Enterococcus tx

Answer 31

Amoxicillin

Question 32

Coliform tx

Answer 32

Gentamicin

Question 33

Sepsis 6 bundle

Answer 33

Blood cultures
Urine output hourly - measures kidney perfusion
Fluid resuscitation - 500ml saline stat
Antibiotics - IV
Lactate - High lactate may mean lots of care required
Oxygen (94-98/ 88-92 COPD)