intra-abdominal sepsis and infection

Question 1

what is bacteraemia ?

Answer 1

The presence of viable bacteria in the blood

Question 2

what is sepsis ?

Answer 2

The systemic inflammatory response to infection

Question 3

what three things make it hard to recognise/diagnose infection?

Answer 3

• abnormal host response
• abnormal microbe response
• site of infection

Question 4

what are the symptoms and signs of local infection?

Answer 4

Pain
Tenderness
Guarding
Blood PR in some

Question 5

what are the symptoms and signs of systemic infection?

Answer 5

fever, 
rigors and chills
nausea or vomiting 
constipation or diarrhoea
malaise/ anorexia

Question 6

SIRS is defined as having ≥2 of the following:

Answer 6

• pulse > 90beats/min
• respiratory rate > 20
• WCC > 12,000 or 10 % immature neutrophils
• temp > 38 or

Question 7

sepsis is ____ with a presumed or confirmed _____

Answer 7

SIRS, infection

Question 8

what is severe sepsis ?

Answer 8

sepsis with signs of at least one acute organ dysfunction

• renal
• respiratory
• hepatic
• haematological
• CNS
• unexplained metabolic acidosis

Question 9

what is septic shock ?

Answer 9

severe sepsis with hypotension refractory to adequate volume resuscitation

Question 10

how is infection diagnosed

Answer 10

blood cuulture, stool, urine, wound, tissue culture

WCC
CRP
platelets, clotting

Question 11

what are the Common community Bacterial Causes of Infection leading to septic syndrome

Answer 11

E.COLI (urine, abdomen) - NOT from gastroenteritis
S.pneumoniae (respiratory)
S. aureus (usually MSSA - skin)

Question 12

what are the Common hospital Bacterial Causes of Infection leading to septic syndrome

Answer 12

E.coli (catheter related or abdomen)

S.aureus (may be MRSA- line or wound related)
Coagulase Negative Staphylococci (line/prosthesis related)
Enterococci (urine, wound, line)
Klebsiella spp (urine, wound)
Pseudomonas spp,.

Question 13

which sites of infection are more likely to lead to bacteraemia?

Answer 13

. complicated urinary tract, pneumonia, endocarditis, meningitis, deep abscess

Question 14

which organisms more liekly lead to bacteraemia?

Answer 14

salmonella typhi

Question 15

people with intra-abdominal sepsis or infection Need _____ management and _____ management

Answer 15

Need antibiotic management and supportive management

Question 16

what is the supportive treatment?

Answer 16

Fluids 
Analgesia 
Need for surgery: exploration, incision-excision and drainage (in abscess) 
VTE prophylaxis
Oxygen 
Control of electrolyte balance 
Need for transfusion

Question 17

after giving antibiotics you should review at ____ hours

Answer 17

48

Question 18

what should be done at 48 hours empirical therapy - antibiotics

Answer 18

should either

1. stop
2. IV/Oral switch
3. change to narrow spectrum
4. continue and review after a further 24 hours

Question 19

what is the sepsis 6 bundle treatment for sepsis?

Answer 19

1. high flow oxygen
2. start IV fluid resus
3. take blood cultures
4. give IV antibiotics
5. measure lactatae and FBC
6. monitor accurately hourly urine output

Question 20

what does increased lactate PRODUCTION signify?

Answer 20

Tissue hypoperfusion

Tissue dysoxia

Question 21

what does reduces lactate METABOLISM signify?

Answer 21

hepatic and renal problems

Question 22

_ is bad, >_ is very bad

Answer 22

2 is bad, >4 is very bad