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Gastroenterology > Intra-abdominal sepsis > Flashcards

Intra-abdominal sepsis Flashcards

1
Q

Peritonitis definition

A

inflammation of the serosal membrane that lines the abdominal cavity (infection or irritants)

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2
Q

What causes primary peritonitis?

A

haematogenous - immunocompromised state

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3
Q

What causes secondary peritonitis?

A

perforation

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4
Q

What causes tertiary peritonitis?

A

persistent or recurrent infection after adequate therapy

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5
Q

What is generalised peritonitis?

A

rigidity
rebound tenderness
guarding
in all 4 abdominal quadrants

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6
Q

What is localised peritonitis?

A

peritoneal signs limited to 1 or 2 abdominal quadrants
may not look unwell

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7
Q

Abdominal signs of peritonitis

A

abdomen that moves with respiration
cough peritonism
percussion tenderness
rebound tenderness

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8
Q

Common causes of secondary peritonitis

A

pancreas - pancreatitis, trauma, iatrogenic

small bowel - ischaemic bowel, incarcerated hernia, closed loop obstruction, Crohn’s, malignancy, meckel diverticulum, trauma

large bowel + appendix - ischaemic bowel, diverticulitis, malignancy, Crohn’s, UC, appendicitis, colonic volvulus, iatrogenic

uterus, salpinx + ovaries - pelvic inflammatory disease, malignancy, trauma

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9
Q

Causes of pain in RUQ

A

cholecystitis
pyelonephritis
ureteric colic
hepatitis
pneumonia

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10
Q

Causes of pain in LUQ

A

gastric ulcer
pyelonephritis
ureteric colic
pneumonia

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11
Q

Causes of pain in RLQ

A

appendicitis
ureteric colic
inguinal hernia
IBD
UTI
gynaecological
testicular torsion

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12
Q

Causes of pain in LLQ

A

diverticulitis
ureteric colic
inguinal hernia
IBD
UTI
gynaecological
testicular torsion

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13
Q

Causes of epigastric pain

A

peptic ulcer disease
cholecystitis
pancreatitis
myocardial infarction

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14
Q

Causes of pain in peri-umbilical region

A

small bowel obstruction
large bowel obstruction
appendicitis
abdominal aortic aneurysm

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15
Q

What is acute mesenteric ischaemia?

A

group of diseases characterised by an interruption of blood supply to varying portions of the small intestine, leading to ischaemia and secondary inflammatory changes
causes intestinal necrosis
life-threatening

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16
Q

Aetiology of acute mesenteric ischaemia

A

mesenteric arterial embolism - AF, MI, endocarditis, vascular grafts

non-occlusive mesenteric ischaemia - systemic shock, hypoperfusion, hypovolaemia

mesenteric arterial thrombosis - advanced age, traumatic injury, peripheral artery disease

mesenteric venous thrombosis - coagulopathy

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17
Q

Risk factors for acute mesenteric ichaemia

A

smoking
dyslipidaemia
hypertension
AF
vasculopathy

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18
Q

Presentation of acute mesenteric ischaemia

A

generalised abdominal pain out of proportion to clinical findings
diffuse + constant pain
nausea + vomiting
non-specific tenderness with no specific clinical signs
generalised or localised peritonitis
embolic sources - eg. AF, heart murmurs - clues for underlying cause

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19
Q

What imaging is diagnostic of acute mesenteric ischaemia?

A

CT scan with IV contrast

oedematous bowel, loss of bowel wall enhancement
pneumatosis
free air
free fluid

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20
Q

Acute mesenteric ischaemia management

A

urgent initial resuscitation
NBM
analgesia
antiemetic
catheter
broad spectrum IV abx

excision of necrotic/non-viable bowel if revascularisation not possible

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21
Q

Appendicitis pathophysiology

A

direct luminal obstruction (faecolith, lymphoid tissue, malignancy)

22
Q

Appendicitis presentation

A

migratory pain (central to RLQ)
anorexia
malaise
nausea
vomiting
percussion tenderness over McBurney’s point
localised peritonism RIF

23
Q

Appendix perforation presentation

A

hypotension
tachycardia
pyrexia

24
Q

Specific signs on examination in appendicitis

A

Rovsing’s sign = RIF pain on palpation of LIF

Psoas sign = RIF pain with extension of right hip - suggestive of retrocaecal appendix abutting the psoas muscle

25
What 2 things should be ruled out in suspected appendicits?
testicular torsion ectopic pregnancy
26
Appendicitis differential diagnosis
gynaecological - ectopic pregnancy, ovarian torsion, cyst rupture, PID renal - kidney stones, UTI, pyelonephritis gastrointestinal - IBD, Meckel's, diverticular disease urological - testicular torsion other - mesenteric adenitis, gastroenteritis
27
Appendicitis investigation
MSU - leukocytes may be present as appendix next to bladder B HcG - rule out ectopic FBC/UE/CRP/Coag
28
Appendicitis management
IV fluids analgesia antiemetics NBM IV ABX laparoscopic appendicectomy (gold standard)
29
Diverticulitis definition
inflammation due to micro-perforation of a diverticulum
30
What is the diverticulum?
sac-like protrusion of the colon
31
Diverticulitis risk factors
low fibre, high fat, red meat diet obesity smoking NSAIDs steroids opiates
32
Diverticulitis presentation
LLQ abdominal pain change in bowel habits (diarrhoea or constipation) nausea/vomiting dysuria - frequency + urgency
33
Diverticulitis signs on examination
tenderness to palpation localised peritonism fever tachycardia hypotension bowel sounds normally hypoactive generalised peritonitis
34
Diverticulitis investigation
FBC, UE, LFT, CRP CT abdomen pelvis with IV contrast - bowel wall thickening, pericolic fat stranding, pericolic fluid, small abscesses confined to colonic wall colonoscopy - 6-8 weeks after symptoms to rule out malignancy, IBD
35
Diverticulitis management
IV ABX analgesia antiemetic bowel rest
36
Diverticulitis complications
POFAB perforation: - intestinal perforation - localised or generalised peritonitis obstruction - stricturing disease fistula - colovesical fistula abscess - pelvic abscess bleeding - PR bleed
37
Types of small bowel obstruction
partial or complete non-strangulated or strangulated
38
Aetiology of small bowel obstructions
post-surgical adhesions incarcerated hernias malignancy IBD stool impaction foreign bodies volvulus
39
Small bowel obstruction presentation
intermittent or progressive abdominal pain, distension, nausea, vomiting constipation/obstipation with or without flatus, loose bowel movements surgical scars, hernias, IBD hx, malignancy
40
Small bowel obstruction examination signs
temperature tachycardia tenderness (3 Ts) abdominal tenderness, generalised/localised peritonism bowel sounds - reduced + high-pitched
41
Small bowel obstruction CT signs
dilated small bowel transition point small bowel faeces sign closed loop obstruction secondary features of strangulation - enhancement of bowel, pneumatosis, portal venous gas, mesenteric stranding, free fluid, free air
42
Small bowel obstruction management
fluids electrolyte correction analgesia antiemetic NBM NG decompression catheter strict fluid balance antibiotics if signs of perforation gastrograffin surgery
43
Is the peritoneal cavity closed or open?
closed in men open in women - via cervix + vagina
44
Intraperitoneal organs
stomach liver gallbladder transverse colon jejunum ileum caecum
45
What is spontaneous bacterial peritonitis (SBP)?
infection of ascitic fluid which arises in the absence of any other source of sepsis within the peritoneum or adjacent tissues
46
What organisms mainly cause spontaneous bacterial peritonitis?
E Coli Streptococci Enterococci typically monobacterial
47
Main risk factors for SBP
alcoholism cirrhosis
48
Common causes of pyrexia in a surgical patient
7Cs: chest (infection) cut (wound infection) catheter (UTI) collections (abdomen, pelvis etc) calves (DVT) cannula (infection) central line (infection)
49
Which antimicrobials target gram-negative organisms?
amoxicillin gentamicin co-amoxiclav cefuroxime ciprofloxacin piperacillin/tazobactam
50
Which antimicrobials target gram-positive organisms?
amoxycillin gentamicin co-amoxyclav piperacillin/tazobactam vancomycin
51
Which antimicrobials target anaerobes?
metronidazole co-amoxiclav piperacillin/tazobactam

Gastroenterology (43 decks)

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