Intra-Abdominal Infections

Question 1

what is diverticulitis

Answer 1

inflammation of diverticula - outpouches of intestinal mucosa

Question 2

presentation of diverticulitis

Answer 2

left iliac fossa pain 
fever
change in bowel habit - constipation (50%) diarrhoea (25%)
PR bleeding 
nausea / vomiting

Question 3

investigations for diverticulitis

Answer 3

FBC: WBC raised, CRP raised

CT scan

Question 4

antibiotics for diverticulitis

Answer 4

cefotaxime + metronidazole

- will require surgery (Hartmanns procedure) if doesn’t settle / if there is perforation or obstruction

Question 5

what is cholecystitis

Answer 5

impaction of gall stone in cystic duct / neck of gall bladder
- can occur with secondary infection

Question 6

presentation of cholecystitis

Answer 6

RUQ pain (can radiate to scapula)
fever, N+V
Murphy’s sign +ve (pain worse on inspiration)

Question 7

investigations for cholecystitis

Answer 7

FBC: WBC raised, CRP raised

USS

Question 8

management of cholecystitis

Answer 8

IV fluids + Antibiotics (amoxicillin, metronidazole, gentamicin)
may require laparoscopic cholecystectomy

Question 9

what is ascending cholangitis

Answer 9

gallstone impacted in common bile duct resulting in infection of biliary tree

Question 10

most common causative organisms in ascending cholangitis

Answer 10

E.Coli / Enterococcus

Question 11

Charcots triad of symptoms in ascending cholangitis

Answer 11

fever, jaundice, RUQ pain

- jaundice is a cholestatic picture – dark urine, pale stools

Question 12

blood results ascending cholangitis

Answer 12

increased WBC, increase bilirubin, increased alkaline phosphatase

Question 13

definitive investigation ascending cholangitis

Answer 13

ERCP

Question 14

management of ascending cholangitis

Answer 14

IV fluids + amox, met, gent

ERCP allows stone removal

Question 15

most common causative organism in a pyogenic liver abscess in

• children
• adults

Answer 15

children - staph aureus

adults- E.Coli

Question 16

management of a pyogenic liver abscess (in adults)

Answer 16

percutaneous drainage + antibiotics

- amoxicillin, ciprofloxacin + metronidazole

Question 17

what patients typically get spontaneous bacterial peritonitis

Answer 17

patients with liver failure

Question 18

most common organism in spontaneous bacterial peritonitis

Answer 18

E.Coli

Question 19

antibiotics given for spontaneous bacterial peritonitis

Answer 19

IV piperacillin/tazobactam

Question 20

what antibiotic is added if the ascitic fluid neutrophil count >250 in spontaneous bacterial peritonitis

Answer 20

Cefotaxime