Intra - abdominal Infection and Sepsis Intro Flashcards
Define Colonisation
The presence of a microbe in a body without inflammatory response
Define Infection
Inflammation due to a microbe
Define bacteraemia
The presence of viable bacteria in the blood
Define sepsis
The systemic inflammatory response to infection
Life threatening organ dysfunction caused by a dysregulated host response to infection
What is septic shock
Subset of sepsis with an increased risk of mortality
What causes an unusual host response
Age
Immunosuppressed
Co-morbidity
Genetics
What causes peritonitis
Leakage of bowel contents results in peritonitis - peritoneal cavity cavity normally sterile
Local S+S of infection
Pain
tenderness
guarding
blood PR
Systemic S+S of infection
Fever Chills or rigors Nausea and Vomiting Constipation or diarrhoea Malaise anorexia
qSOFA
RR>22bpm
sBP <100mmHg
Altered GCS
0=mortality <1%
1 = mortality 2-3%
>/ = mortality >/10%
What does the aSOFA screen for
Mortality risk as opposed to cause
What is the cause of E.coli bacteraemia in the community
Urine, abdomen
What is the cause of E.coli bacteraemia in the hispital
Catheter related or abdomen
What is a coliform
E. coli and other organisms that inhabit the large bowel
What is a strict aerobe
Organisms that require oxygen for growth pseudomonas sp
What is an aerorbes organism
One that grows best in oxygen but can also grow without it - e.g. staph, strep, enterococci, coliforms
Strict anerobes
Organisms that will not survive in oxygen - e.g. clostridium, bacteroides, anaerobic cocci
Normal flora of the mouth
Strep viridans Nissiera Anaerobes Few Candida Staph
Stomach normal flora
Normall sterile
Few staph and candida may survive
Jejunum normal flora
Small numbers of coliforms and anaerobes
Colon normal flora
Large no. of coliforms, anaerobes, enterococcus faecalis
Bile ducts normal flora
usually sterile
What is used to treat streptococci and enterococci
amoxicillin
What is used to treat aerobic coliforms
Gentamicin
What is used to treat anaerobes
Metronidazole
How can a small abscess be treated
Antibiotics
How is a large abscess treated
Incision and drainage
What is the treatment of intra - abdominal sepsis
Gentamicin, metronidazole, amoxicillin
What is the treatment if intra abdominal sepsis if you are penicillin allergic
Gentamicin, metronidazole, co trimoxazole
Prophylactic GI treatment
Gentamicin and metronidazole
Enterococcus tx
Amoxicillin
Coliform tx
Gentamicin
Sepsis 6 bundle
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)
