Intraabdominal Infections

Question 1

What is the definition of intraabdominal infections

Answer 1

Presence of microorganisms in normally sterile sites within the abdominal cavity

Question 2

What types of bacteria do you find in the stomach

Answer 2

Considered to be sterile

Question 3

What types of bacteria do you find in the prox. small intestine

Answer 3

Relatively free of microorganisms. Growth inhibited by bile. A few aerobic bacteria and candida

Question 4

How many organisms/gram do you find in the large intestine?

Answer 4

10(9)-10(11)

Question 5

Is the large intestine pred. covered with aerobic or anaerobic bacteria?

Answer 5

Anaerobic bacteria (95-99%)

Question 6

3 mechanisms of intra-abdominal infection

Answer 6

1. translocation of micro-organisms from GI tract lumen to peritoneal cavitye.g. intraperitoneal infections
2. transolcation of micro-organisms across a lumen e.g. biliary tract/hepatobiliary infections
3. translocations of microorganims from an extra-intestinal source e.g. penetrating trauma, haematogenous spread

Question 7

Give 3 examples of when you can get translocation across a wall

Answer 7

Performation e.g. appendix
Loss of integrity e..g strangulation, ischaemia
Surgery e.g. seeding at operation, anastomotic leak

Question 8

Give 2 examples of when you can get translocation across a lumen

Answer 8

Blockage e.g. cholecystitis

Iatrogenic e.g. instrumentation

Question 9

Outine the 3 stages of perforated appendix

Answer 9

1. stagnation of luminal contents, bacterial growth and recruitment of inflammatory cells
2. build up of intraluminal pressure
3. escape of luminal contents into peritoneal cavity

Question 10

Inflammation of the gall bladder wall, associated iwth obstruction of the cystic duct e.g. gallstones, malignancy, surgery

Answer 10

Cholecytitis

Question 11

Clinical presentation of cholecystitis

Answer 11

Fever, right upper quadrant pain, mild jaundice

Question 12

Intramural gas in gall bladder wall

Answer 12

Emphysematous cholecystitis

Question 13

Complication of cholecystitis- pus in the gall bladder

Answer 13

Empyema of the gall bladder

Question 14

Which differences are there in the clinical presentations of cholecystitis and empyema of the gall bladder

Answer 14

Same presenations but empyema in addition presents with severe pain, high fever, chills and rigors

Question 15

Inflammation.infection of biliary tree

Answer 15

Cholangitis

Question 16

Collection of pus in the lvier

Answer 16

Pyogenic liver abscess

Question 17

Localised area of peritonitis with build up of pus

Answer 17

Intraperitoneal abscess

Question 18

Presentation of intraperitoneal abscess

Answer 18

non specific. Sweating, anorexia or pyrexia

Question 19

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

Answer 19

Subphrenic abscess

Question 20

What type of intraperitoneal abscess presents with urinary frequency, tenesmus (bowel frequency)

Answer 20

Pelvic abscess

Question 21

Infected ascitic fluid

Answer 21

Spontaneous bacterial peritonitis

Question 22

Amoebic abscess is caused by what parasite

Answer 22

Entamoeba histolytica

Question 23

Hyatid cyst is caused by what bacteria

Answer 23

Echinoccocus granulosus

Question 24

Give 2 examples of aerobic gram -ve bacilli

Answer 24

Enterobacteriaceae/coliforms e.g. E.coli

Pseudomonas

Question 25

Give 1 example of an anaerobic gram -ve bacilli

Answer 25

Bacteroides

Question 26

Give 1 example of an aerobic gram +ve cocci

Answer 26

Enterococcus

Question 27

Give 1 example of an anerobic gram +ove bacilli

Answer 27

Clostridium

Question 28

Liver abscesses are commonly caused by what bacteria?

Answer 28

Usually polymicrobial

Question 29

What antibiotics are given to people with intraperitoneal infections

Answer 29

65yrs: piperacillin/tazobactam

Question 30

When do you switch to oral antibiotics?

Answer 30

After 48hrs apyrexial with normal white cell count