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DOOS3 > Intraabdominal infections-Table 1 > Flashcards

Intraabdominal infections-Table 1 Flashcards

1
Q

What is considered a left shift?

A

> 70%neutrophils

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2
Q

What is an important thing to remember about diverticulitis and lab findings?

A

They will NOT always have an elevated white count!! Don’t assume they aren’t sick because the WBC are WNL

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3
Q

What causes the early alkalosis in secondary and tertiary peritonitis?

A

Hyperventilation and vomiting

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4
Q

Which microbes can survive in the stomach?

A

H pylori and C diff spores

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5
Q

What is the predominant in the large bowel?

A

B frag

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6
Q

What abx covers B frag?

A

Pip/taz

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7
Q

What are the bacteria that predominate intra-abdominal infections?

A

Aerobic bacteria: ecoli, kleb, enterococcus, pseudomonas( mainly health care
Anaerobic bacteria: b frag

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8
Q

What should you suspect if you find staph a in the abdomen?

A

Introduction from a surgical procedure

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9
Q

Why is amp/sulb not recommended in mild-mod intra abdominal infection?

A

Too much e coli resistance

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10
Q

Why are cefotetan and clindamycin not recommended in mild-mod intraab infections?

A

There is too much b frag involved and way too much resistance! Don’t ever use these

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11
Q

Is empiric coverage of enterococcus recommended in mild-mod intra ab infections?

A

No, this isn’t necessary for community acquired

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12
Q

What is the tx for community associated mild-mod intra ab infection?

A 
•Cipro plus metronidazole
OR
•Cefazolin plus metronidazole
OR
Ceftriaxone plus metronidazole
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13
Q

What is the tx for community associated severe intra ab infections?

A 
•Cipro plus metronidazole
OR
•Cefepime plus metronidazole 
OR
•Piperacillin/tazobactam
OR
•Meropenem  (severe PCN allergy/high suspicion of ESBL)
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14
Q

How is health care associated tx?

A

Severe as above

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15
Q

In a non-septic pt presenting to the health care setting, how much time do you have as a provider before your pts needs to receive abx?

A

8 hours maximum

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16
Q

How long do you have before you need to admin abx to a pt presenting in sepsis?

A

Tx within an hour

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17
Q

If a pt has a perfed appendix and the c/s is showing more than one organism, what should you prescribe coverage for?

A

Anaerobes- even if none grew!

18
Q

What is the duration of abx therapy in an established mild-mod intraab infection?

A

4-7 days, unless no source control

19
Q

What broadspec abx have near 100% coverage for B frag?

A

Pip/tazo
Amp/sulb
Carbapenems

20
Q

Do the above drugs need metro as a companion to cover anaerobes?

A

NO

21
Q

What are PO options for mild-mod intraab infections?

A 
•Cipro + metronidazole 
•Levofloxacin + metronidazole 
•Moxifloxacin + metronidazole 
•Cephalexin + metronidazole 
•Cefuroxime + metronidazole (improved E coli coverage)– preferred 
Amoxicillin/clavulanic acid*
22
Q

What is the duration of therapy for an abscess if it is drained? Undrained?

A
  • 3-7 days after the drainage

- weeks based

23
Q

What is the duration of therapy for non perf appendicitis? perfed?

A
  • periop prophylaxis single dose to 24 hours

- 4-7 days

24
Q

How long is the duration of therapy for cholecystitis if nonoperative? What is the duration of therapy for cholecystitis with non perf and perf?

A
  • 5-10 days
  • up to 24 hrs hours
  • 4-7 days
25
Q

What is the duration of therapy for uncomplicated diverticulitis? Mod-severe divertic?

A
  • none

- 4-7 days

26
Q

What is the duration of therapy for early intervention gastro duodenal perf ( 24hrs)?

A
  • perioperative prophylaxis

- 4- 7 days

27
Q

What is the duration of therapy for non-necrotic pancreatitis without pancreatitis? For necrotic with infection?

A
  • none

- 4-7

28
Q

What is the duration of therapy for peritonitis?

A

4-7 days

29
Q

What is primary peritonitis?

A

spontaneous, monomicrobial infection of ascitic fluid and peritoneal membrane in pts w/ESLD

30
Q

What is secondary peritonitis?

A

related to pathological process in visceral organ. Peritoneal infections that arise from hollow viscus inflammation and/or perforation (contained/tx by source control procedure and antibiotics)

31
Q

What is the clinical presentation of acute cholecystitis?

A

abd pain, usu RUQ or epigastric. Pain usu steady and severe, N/V/anorexia. Fatty food intake prior to attack.

32
Q

What are the common bugs that infect the bile?

A

E coli (41%) , Enterococcus (12%) , Klebsiella, Enterobacter

33
Q

How is acute cholecystitis diagnosed?

A

Clinical picture +gallstones on imaging

34
Q

What lab values are associated with acute cholecystitis?

A

•↑WBC, TBili, AlkPhos often normal.

35
Q

What are the imaging modalities for acute cholescytitis?

A
  • US (+ stones, thickened GB wall)
  • HIDA (cholescintigraphy)—IV radionuclide taken up by liver, excreted into bile
  • MRCP (magnetic resonance)—noninvasive method to eval bile ducts
36
Q

What is the tx for acute chole?

A

Urgery and abx to decrease wound infection for 24-48hrs postop

37
Q

What are the most common bugs in necrotizing pancreatitis?

A

E coli, Pseudomonas, Klebsiella, Enterococcus

38
Q

When would you tx necrotizing pancreatitis prophylactically?

A

If there is extensive necrosis tx with abx 7-10 days

39
Q

What is the potential harm in tx prophylactically? What is really the best way to tx?

A

Potential for superimposed fungal infection

Wait until you know what is causing the infection BEFORE starting abx

40
Q

How if infected necrosis diagnosed?

A

CT guided percut aspiration

41
Q

What is the tx of choice for necro pancreatitis?

A

Surgical debridement then abx based on C/S

DOOS3 (12 decks)

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