Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GIT medicine > Intra-abdominal sepsis > Flashcards

Intra-abdominal sepsis Flashcards

You may prefer our related Brainscape-certified flashcards:
Git Commands flashcards
1
Q

DEFINE sepsis SIRS

A
  • Sepsis = SIRS +infection
  • SIRS - two or more of
    • tachycardia
    • > 38 or <36
    • RR above 20 or CO2 <32 mmHg
    • WBC >12000, <4000, or >10% band forms

Mortality 10-15%
Mortality 17-20%
Sepsis with organ dysfunction:
- SBP<90 or MAP<65
- INR>1.5
- Biliruibin >34
- UO <0.5ml/kg/h
- Creatinine >177
- Plt <100
- Sats ><90% on RA
- shock = Mortality 40-50% Sepsis with refractory hypotension

A spectrum from SIRS to sepsis to severe to septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some immediate measures to take for suspected spsis?

A
  • measure lactatte
  • obtain blood cultures pre
  • adminster braod spectrum atibiotics
  • crystalloid for hypotension, or lactate
  • resus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some potnetial causes?

A

Clinical Classification
- RUQ:
- Cholecystitis
- Liver pathology
- RLL pneumonia
- RLQ:
- Appendicitis
- Ovarian pathology
- Pyelonephritis
- Right sided diverticulitis
- Epigastric:
- Peptic ulcer disease
- Pancreatitis (usually radiates to back)
- Inferior myocardial infarct
- LLQ:
- Diverticulitis
- Ovarian pathology
- Pyelonephritis
- LUQ rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Possible cuases by anatomy (gastro duo)

A
  • Perforated peptic ulcer (mild until perforated = severe)
    • Gastric
    • Duodenal
  • Boerhaave’s syndrome
    • Spontaneous oesophageal rupture - severe and high mortality, rare
  • Iatrogenic injury
    • Gastroscopy
    • ERCP
    • PEG tube
  • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Possible anatomical causes (liver gall panc)

A
  • Liver abscess - uncommon, pyogenic or non
  • Biliary colic – cholecystitis
  • Cholangitis (jaundice, fever, RUQ)
  • Gallstone ileus
  • Bile duct injury or bile leak after cholecystectomy
  • Acute pancreatitis - usu due to gall stones or alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Possible causes: small bowel

A
  • Meckel’s diverticulitis
  • Small bowel obstruction- usu due to adhesions
  • Acute mesenteric ischaemia- uncommon
  • Inflammatory bowel disease eg Crohn’s
  • Hernia involving small bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

POSSIBLE ANATOMICAL COLON RECTUM APPENIDX

A
  • Appendicitis
  • Diverticulitis
    • Right side
    • Sigmoid
  • Inflammatory bowel disease
  • Infectious or ischaemic colitis
  • Volvulus
    • Sigmoid
    • Caecal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Other anatomical causes

A
  • Kidneys, ureter, bladder
    • Renal colic
    • Pyelonephritis
    • Renal abscess
    • Cystitis
  • Female reproductive organs
    • Pelvic inflammatory disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common causes

A
  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Diverticulitis
  • Perforated ulcer
  • Ischaemic bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical presentation fo appendicitis

A
  • Migratory abdominal pain (periumbilical –>RLQ)
  • Loss of appetite, nausea/vomiting
  • common young
  • Fever
  • RLQ peritonitis (push on left - pain on right)
  • Rovsing’s, obturator positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnsois of appendicitis

A
  • Clinical diagnosis (Especially in young, men)
  • Suspicious raised by elevated inflammatory markers
  • If doubt about diagnosis, imaging:
    • US vs CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe management of spesis due to appendix

A
  • Triple antibiotics (metronidazole, ampicillin, gentamicin)
  • Surgery - timing depends on patient stability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Desribe clinical presentation fo cholecystitis

A
  • History of biliary colic, worse with food
  • Persistent RUQ pain
  • Nausea, vomiting, loss of appetite, fever
  • Murphy’s positive - push RUQ take a breath – sharp pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dx cholecystitis

A
  • Ultrasound (thickened wall, increased vascularity, pericholecystic fluid, tenderness to probe)
  • Assess LFTs to determine likelihood of choledocholithiasis
  • Ensure Lipase is not elevated - differential for pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe management of sepsis due to appendix

A
  • Antibiotics - triple
  • Surgery - depends septic or no
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe clincial presentation pancreatitis

A
  • Epigastric pain radiating to back
  • Nausea, vomiting, loss of appetite
  • Fever
17
Q

Describe pancreatitis dx, what and how to rule out ddx, and how to classify disease

A
  • 2/3 of:
    • Clinically typical symptoms
    • Elevated lipase >3x upper limit normal
    • CT findings consistent with pancreatitis
  • Identify cause:
    • Biliary ultrasound - gstones
    • Screen for secondary causes (Lipids, Igg4 subclasses, Ca 19.9, MRCP)
  • classification mild moderate severe depending on local complications, organ failure and timeline of failure
18
Q

SIRS mgmt pancreatitis

A
  • No antibiotics
  • Supportive care
  • Prevent further episodes
    • Cholecystectomy prior to discharge if gallstones are the cause
  • Treat complications of pancreatitis
  • Avoid surgery (mostly)
19
Q

Deescribe the clincial presenation of diverticulitis

A
  • LLQ pain
  • Fever
  • Diarrhoea or constipation
  • LLQ or suprapubic peritonitis
20
Q

DX diverticulitis

A
  • Elevated inflammatory markers
  • CT diagnosis
  • CT also used to assess severity
21
Q

Sepsis managemnt diverticultiis

A
  • Antibiotics
  • Control of sepsis
    • Abscess -> drainage
    • Purulent or faeculant peritonitis -> surgery
22
Q

Clinical signs perfoated ulcer

A
  • Sudden onset upper abdominal pain
  • Fever, nausea
  • History of NSAIDs without PPI, smoking, untreated helicobacter pylori
  • Peritonitis in upper abdomen
23
Q

Dx perforated ulcer

A
  • CT showing free gas and free fluid in upper abdomen; lipase normal
24
Q

perforated ulcer managemtn spesis

A
  • Antibiotics (triple)
  • Surgery
25
Q

What is ischaemic bowel the end point of?

A
  • Mesenteric ischaemia - eg atrial fibrillation and embolism, chronic ischaemia with thrombosis/stricture
  • Strangulated hernia - venous congestion, arterial insufficiency
  • Closed loop adhesional small bowel obstruction
26
Q

Clinical presentation ischaemic bowel

A
  • Non-specific abdominal pain (may or may not localise, various regions)
  • Pain out of proportion to examination
  • Can be difficult to diagnose, needs high degree of suspicion
27
Q

Dx ischaemic bowel

A
  • CT (may see thickened wall, free fluid)
  • Lactate sometimes elevated (not always)
28
Q

Mgmt sepsis ischaemic bowwel

A
  • Antibiotics
  • Surgery

GIT medicine (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions