Intraabdominal infections and abscesses

Question 1

Most common manifestation of Primary spontaneous bacterial peritonitis

Answer 1

Fever

Question 2

Common cell count finding in ascitic fluid in PBP

Answer 2

> 250 PMNs/uL is diagnostic for PBP

Question 3

Treatment for PBP

Answer 3

should cover gram-negative aerobic bacilli and gram-positive cocci

3rd gen cephalosporin (cefotaxime 2g IV q8h or ceftriaxone 2 gm q24) or penicillin/B lactamase inhibitor combinations (Piptazo 3.375 gm IV q6h

Question 4

develops when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus

Answer 4

Secondary peritonitis

Question 5

Treatment of secondary bacterial peritonitis

Answer 5

includes early administration of antibiotics aimed particularly at aerobic gram-negative bacilli and anaerobes

Question 6

Etiologic agent of Continuous ambulatory peritoneal dialysis (CAPD) peritonitis

Answer 6

skin organisms

Question 7

Characteristics of dialysate in patients with CAPD peritonitis

Answer 7

cloudy and contains > 100 WBC/uL, >50% of which are neutrophils

Question 8

Most common causative agent for CAPD peritonitis

Answer 8

Staphylococcus aureus

Question 9

Empirical treatment for CAPD peritonitis

Answer 9

directed at S. aureus, ConS, and gram-negative bacilli until the results of cultures become available

Options
Cefazolin and a fluoroquinolone or a 3rd generation cephalosporin

Question 9

Empirical treatment for CAPD peritonitis

Answer 9

directed at S. aureus, ConS, and gram-negative bacilli until the results of cultures become available

Options
Cefazolin and a fluoroquinolone or a 3rd generation cephalosporin
MRSA - vancomycin + gram negative coverage with an aminoglycoside, ceftazidime, cefepime or a carbapenem

Question 10

Indication for immediate removal of CAPD catheter

Answer 10

Fungal infection

Question 11

forms in untreated peritonitis if overt gram-negative sepsis either does not develop or develops but is not fatal

Answer 11

Intraabdominal abscess

Question 12

imaging with highest yield for intrabadominal abscess

Answer 12

Abdominal CT

Question 13

Algorithm for the management of patients with intraabdominal abscess by percutaneous drainage

Answer 13

Question 14

Principle of treatment of intraabdominal infections

Answer 14

involves determination of the initial focus of infection, adminsitration of broad-spectrum antibiotics targeting the organisms involved and performance of a drainage procedure if one or more definitive abscesses have formed

Question 15

Most common associated disease with liver abscess

Answer 15

diseases of the biliary tract

Question 16

Most common presenting sign of liver abscess

Answer 16

Fever

Question 17

Single most reliable laboratory finding of liver abscess

Answer 17

Elevated serum concentration of alkaline phosphatase (seen in >70% of patients)

Question 18

Imaging studies for liver abscesss

Answer 18

Ultrasonography, CT scan, indium-labeled WBC or gallium scan, and MRI

Question 19

Mainstay of therapy for intrabdominal abscesses

Answer 19

Drainage

Question 20

Factors predicting the failure of percutaneous drainage and therefore may favor primary surgical intervention

Answer 20

1. multiple sizable abscesses
2. viscous abscess contents that tend to plug the catheter
3. associated disease (disease of the biliary tract) requiring surgery
4. presence of yeast
5. communication with an unteated obstructed biliary tree
6. lack of a clinical response to percutaneous drainage in 4-7 days

Question 21

Treatment of candidal liver abscess

Answer 21

initial administration of liposomal amphotericin B (3-5 mg/kg IV daily) or an echinocandin with subsequent fluconazole therapy

-clinically stable: may use fluconazole alone (6 mg/kg daily)

Question 22

Most common associated infection for splenic abscess

Answer 22

Bacterial endocarditis

Question 23

Most sensitive diagnostic tool for splenic abscess

Answer 23

CT scan of the abdomen

Question 24

Most common bacterial isolate from splenic abscess

Answer 24

Streptococcal sp

Question 25

Standard of treatment for splenic abscess

Answer 25

Splenectomy with adjunctive antibiotics

Question 26

Most important factor in successful treatment of splenic abcess

Answer 26

Early diagnosis

Question 27

Organisms that need to be covered through vaccination in patients who will undergo splenectomy

Answer 27

Encapsulated organisms
- Streptococcus pneumoniae, Haemophilus influenza, Neisseria meningitidis

Question 28

Most common cause of perinephric and renal abscesses

Answer 28

Urinary tract infection (>75%)

Question 29

Most important risk factor associated with the development of perinephric abscess

Answer 29

Concomitant nephrolithiasis obstructive urinary flow

Question 30

Most frequently encountered organisms in perinephric and renal abscess

Answer 30

E. coli, Proteus sp, and Klebsiella sp

Question 31

Hallmark of candidal renal abscess caused by ascension from the baldder

Answer 31

Ureteral obstruction with large fungal balls

Question 32

Most useful diagnostic modalities for renal abscess

Answer 32

Renal ultrasonography and abdominal CT

Question 33

Treatment for perinephric and renal abscess

Answer 33

Includes drainage of pus and antibiotic therapy directed at the organisms recovered

Question 34

Treatment of Psoas abscess

Answer 34

surgical drainage and administration of an antibiotic regimen directed at the inciting organisms

Question 34

Treatment of Psoas abscess

Answer 34

surgical drainage and administration of an antibiotic regimen directed at the inciting organisms