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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
Q

What 2 things should be ruled out in suspected appendicits?

A

testicular torsion
ectopic pregnancy

26
Q

Appendicitis differential diagnosis

A

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
Q

Appendicitis investigation

A

MSU - leukocytes may be present as appendix next to bladder
B HcG - rule out ectopic
FBC/UE/CRP/Coag

28
Q

Appendicitis management

A

IV fluids
analgesia
antiemetics
NBM
IV ABX
laparoscopic appendicectomy (gold standard)

29
Q

Diverticulitis definition

A

inflammation due to micro-perforation of a diverticulum

30
Q

What is the diverticulum?

A

sac-like protrusion of the colon

31
Q

Diverticulitis risk factors

A

low fibre, high fat, red meat diet
obesity
smoking
NSAIDs
steroids
opiates

32
Q

Diverticulitis presentation

A

LLQ abdominal pain
change in bowel habits (diarrhoea or constipation)
nausea/vomiting
dysuria - frequency + urgency

33
Q

Diverticulitis signs on examination

A

tenderness to palpation
localised peritonism
fever
tachycardia
hypotension
bowel sounds normally hypoactive
generalised peritonitis

34
Q

Diverticulitis investigation

A

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
Q

Diverticulitis management

A

IV ABX
analgesia
antiemetic
bowel rest

36
Q

Diverticulitis complications

A

POFAB
perforation:
- intestinal perforation - localised or generalised peritonitis

obstruction - stricturing disease

fistula - colovesical fistula

abscess - pelvic abscess

bleeding - PR bleed

37
Q

Types of small bowel obstruction

A

partial or complete
non-strangulated or strangulated

38
Q

Aetiology of small bowel obstructions

A

post-surgical adhesions
incarcerated hernias
malignancy
IBD
stool impaction
foreign bodies
volvulus

39
Q

Small bowel obstruction presentation

A

intermittent or progressive abdominal pain, distension, nausea, vomiting

constipation/obstipation with or without flatus, loose bowel movements

surgical scars, hernias, IBD hx, malignancy

40
Q

Small bowel obstruction examination signs

A

temperature
tachycardia
tenderness (3 Ts)

abdominal tenderness, generalised/localised peritonism

bowel sounds - reduced + high-pitched

41
Q

Small bowel obstruction CT signs

A

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
Q

Small bowel obstruction management

A

fluids
electrolyte correction
analgesia
antiemetic
NBM
NG decompression
catheter
strict fluid balance
antibiotics if signs of perforation
gastrograffin

surgery

43
Q

Is the peritoneal cavity closed or open?

A

closed in men
open in women - via cervix + vagina

44
Q

Intraperitoneal organs

A

stomach
liver
gallbladder
transverse colon
jejunum
ileum
caecum

45
Q

What is spontaneous bacterial peritonitis (SBP)?

A

infection of ascitic fluid which arises in the absence of any other source of sepsis within the peritoneum or adjacent tissues

46
Q

What organisms mainly cause spontaneous bacterial peritonitis?

A

E Coli
Streptococci
Enterococci
typically monobacterial

47
Q

Main risk factors for SBP

A

alcoholism
cirrhosis

48
Q

Common causes of pyrexia in a surgical patient

A

7Cs:
chest (infection)
cut (wound infection)
catheter (UTI)
collections (abdomen, pelvis etc)
calves (DVT)
cannula (infection)
central line (infection)

49
Q

Which antimicrobials target gram-negative organisms?

A

amoxicillin
gentamicin
co-amoxiclav
cefuroxime
ciprofloxacin
piperacillin/tazobactam

50
Q

Which antimicrobials target gram-positive organisms?

A

amoxycillin
gentamicin
co-amoxyclav
piperacillin/tazobactam
vancomycin

51
Q

Which antimicrobials target anaerobes?

A

metronidazole
co-amoxiclav
piperacillin/tazobactam

Gastroenterology (43 decks)

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