Intra-abominal Infection - Block 2 Flashcards
What is an intraabdominal infection?
Infection of peritoneum within peritoneal cavity or retroperitoneal space
GI flora in stomach?
Streptococcus
Lactobacillus
GI flora in biliary tract?
Normally sterile (E. coli, Klebsiella, or enterococci)
GI flora in proximal small bowel?
Strep, Enterococci, E. coli, Kleb, Lactobacillus, diphtheroids
GI flora in distal ileum?
E. coli, Kleb, Enterobacter, enterococci, Bacterides, Clostridium, peptostrep
GI flora in colon?
- Enterobacteriaceae
- Enterococci
- anaerobes
- candida
What is uncomplicated IAI?
- Affects a single organ
- Doesn’t spread to peritoneum
- No anatomic disruption of the GIT
What is complicated IAI?
- Extension of infection into peritoneal space
- May be contained/localized or cause diffuse peritonitis
The most common
Differentiate the types of peritonitis?
Primary: Spontaneous bacterial peritonitis (SBP)
Secondary: disruption of GIT, involve in polymicrobial infection
Tertiary: persists or recurs at least 48hrs after apparently adequate management of primary and secondary
What is the most common cause of primary peritonitis?
Alcoholic
Cirrhosis or ascites
PD
Pathogen associated with cirrhosis?
E. coli
Pathogen associated with PD?
Staph spp.
Sterptococcus
E. coli
Klebsiella
Pseudomonas
What are the causes of secondary peritonitis?
Breach of GI mucosal membrane due to:
1. Abscess
2. Polymicrobial infection
RF of developing candida infection?
- Extensive broad ABX
- Immunosuppressed patients
What are the common causes of secondary bacterial peritonitis?
- Diverticulitis
- Appendicitis
- IBD
- Billiary tract infection
- Intestinal obstruction
- Perforation
- Trauma
Pathogens assocaited with 2nd peritonitis?
- Strep
- E. coli
- Kleb
- Enterococci
RF for primary peritonitis?
PPI use
RF for secondary peritonitis?
- Advanced age
- Obesity
- Smoking
- Lack fo exercise
- Low fiber
- Gallstones
- Cholangitis
- Biliary tract colonization
S/s of primary peritonitis?
GI upset
Bowel sounds hypoactive
PD: clouding dialysate fluid
Lab of primary peritonitis?
- Mild elevated WBC
- Elevated Procal
- Fever
- Ascites fluid leukocytes >250
- Bacterial growth in ascites or dialysate
- Protein <1 -> hepatic impairment
- Glucose >50