Intraabdominal Infections Flashcards
What is the definition of intraabdominal infections
Presence of microorganisms in normally sterile sites within the abdominal cavity
What types of bacteria do you find in the stomach
Considered to be sterile
What types of bacteria do you find in the prox. small intestine
Relatively free of microorganisms. Growth inhibited by bile. A few aerobic bacteria and candida
How many organisms/gram do you find in the large intestine?
10(9)-10(11)
Is the large intestine pred. covered with aerobic or anaerobic bacteria?
Anaerobic bacteria (95-99%)
3 mechanisms of intra-abdominal infection
- translocation of micro-organisms from GI tract lumen to peritoneal cavitye.g. intraperitoneal infections
- transolcation of micro-organisms across a lumen e.g. biliary tract/hepatobiliary infections
- translocations of microorganims from an extra-intestinal source e.g. penetrating trauma, haematogenous spread
Give 3 examples of when you can get translocation across a wall
Performation e.g. appendix
Loss of integrity e..g strangulation, ischaemia
Surgery e.g. seeding at operation, anastomotic leak
Give 2 examples of when you can get translocation across a lumen
Blockage e.g. cholecystitis
Iatrogenic e.g. instrumentation
Outine the 3 stages of perforated appendix
- stagnation of luminal contents, bacterial growth and recruitment of inflammatory cells
- build up of intraluminal pressure
- escape of luminal contents into peritoneal cavity
Inflammation of the gall bladder wall, associated iwth obstruction of the cystic duct e.g. gallstones, malignancy, surgery
Cholecytitis
Clinical presentation of cholecystitis
Fever, right upper quadrant pain, mild jaundice
Intramural gas in gall bladder wall
Emphysematous cholecystitis
Complication of cholecystitis- pus in the gall bladder
Empyema of the gall bladder
Which differences are there in the clinical presentations of cholecystitis and empyema of the gall bladder
Same presenations but empyema in addition presents with severe pain, high fever, chills and rigors
Inflammation.infection of biliary tree
Cholangitis
Collection of pus in the lvier
Pyogenic liver abscess
Localised area of peritonitis with build up of pus
Intraperitoneal abscess
Presentation of intraperitoneal abscess
non specific. Sweating, anorexia or pyrexia
What type of intraperitoneal abscess presents with pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly and ipsilateral lung collapse with pelural effusion
Subphrenic abscess
What type of intraperitoneal abscess presents with urinary frequency, tenesmus (bowel frequency)
Pelvic abscess
Infected ascitic fluid
Spontaneous bacterial peritonitis
Amoebic abscess is caused by what parasite
Entamoeba histolytica
Hyatid cyst is caused by what bacteria
Echinoccocus granulosus
Give 2 examples of aerobic gram -ve bacilli
Enterobacteriaceae/coliforms e.g. E.coli
Pseudomonas
Give 1 example of an anaerobic gram -ve bacilli
Bacteroides
Give 1 example of an aerobic gram +ve cocci
Enterococcus
Give 1 example of an anerobic gram +ove bacilli
Clostridium
Liver abscesses are commonly caused by what bacteria?
Usually polymicrobial
What antibiotics are given to people with intraperitoneal infections
65yrs: piperacillin/tazobactam
When do you switch to oral antibiotics?
After 48hrs apyrexial with normal white cell count
