Intrabdominal infections

Question 1

define intrandominal infection

Answer 1

presence of micro-organism in normally sterile sites within the abdominal cavity e.g. peritoneal cavity and hepatobillary tree.

Question 2

why is gastroenteritis not classed as a intrabdominal infection

Answer 2

bowel lumen is not sterile

Question 3

which areas of the stomach and small intestine are sterile

Answer 3

stomach

proximal small intestines- bile and acid from stomach kill all pathogens.

Question 4

what is the normal amount of flora in the large intestine ? 10 ^

Answer 4

10^9-11

Question 5

what pathogens mainly occupy the large intestine flora

Answer 5

anaerobic bacteria (95-99%)

Question 6

3 main sources of intrabdominal organs

Answer 6

GI contents, blood, external

Question 7

defien intrapertioneal.

Answer 7

• Translocation of micro- organisms from gastrointestinal tract lumen to peritoneal cavity

Question 8

define billary tract infection

Answer 8

• Translocation of micro-organism along a lumen- up to liver

Question 9

define haematogenous spread

Answer 9

• Translocation of micro-organism from a extra-intestinal source- penetrating trauma

Question 10

how can traslocation of an organism across a wall occur

Answer 10

• Perforation-Perforated appendix, perforated ulcer, perforated diverticulum, malignancy
• Loss of integrity- Ischemia, strangulation (herniation of bowel)
• Surgery- Seeding at operation, anastomotic leak (as it is incomplete or it has broken down).

Question 11

how can traslocation of an organism along a lumen occur

Answer 11

• Blockage- Cholecystitis, cholangitis, hepatic abscess
– Gall bladder is not normally sterile but bile keeps it sterile, so blockage will mean that no bile can pass so organisms can harbour
• Iatrogenic- Instrumentation (e.g. ERCP)- endoscopic retrograde cholangio pancreatography.

Question 12

causes of obstruction of lumen of vermiform appendix.

example of translocation across a wall- appendicitis

Answer 12

– Lymphoid hyperplasia, faecal obstruction, stagnation of luminal contents, bacterial growth and recruitment of inflammatory cells.
– Build up of intraluminal pressure may result in perforation
– Escape of luminal contents into peritoneal cavity is “peritonitis”

Question 13

symptoms of appendicitis

Answer 13

temperature, severe generalised pain.

Question 14

treat for appendicitis

Answer 14

appendicecectomy and cefuroxime, and metronidazole for 5 days.

Question 15

what form of intra abdominal infection is appendicitis

Answer 15

translocation across wall

Question 16

what form of intraabdominal infection is perforated diverticula

Answer 16

translocation across wall

Question 17

define perforated diverticulum

Answer 17

• Herniation of mucosa and sub mucosa through muscular layer

Question 18

common complication of bowel cancer

Answer 18

Intraperitoneal and/or bloodstream infection

Question 19

what organism cause Intraperitoneal and/or bloodstream infection in bowel cancer

Answer 19

clostridium septicum and streptococcus gallolyticus

Question 20

symptoms of bowel cancer

Answer 20

weight loss, alteration of bowel habits, and blood in stool.

Question 21

what causes ischaemia of the bowel

Answer 21

– Strangulation
– Arterial occlusion
– Post operative
– E.g. Aneurysm repairs.

• Interruption of intestinal blood supply

Question 22

how does ischaemia result in translocation of lumina contents

Answer 22

lack of blood supply results in gut wall loses structurally and integrity

Question 23

causes of post operative infections

Answer 23

• Seeding at operation
– Incidence is reduced due to bowel preparation with prophylactic antibiotics- prior to surgery.
• Anastomotic leak- due to breakdown or due to non formed anastomosis
• Acute infection- abdominal pain and tenderness, shock
• Intraperitoneal abscess- walled off abscess, more indolent condition (presents some weeks after surgery).

Question 24

define cholecystitis

Answer 24

inflammation of the gall bladder

Question 25

symptoms of cholecystitis

Answer 25

fever, right upper quadrant pain, mild jaundice.

Question 26

clinical presentation of empyema in the gallbladder

Answer 26

severe pain, High fever, Chills and rigors.

Question 27

empyema of the gallbladder is a complication of what condition

Answer 27

cholecystitis

Question 28

define cholangitis

Answer 28

• Inflammation/infection of biliary tree

Question 29

causes of cholecystisis and cholangitis

Answer 29

– Mainly obstruction of common bile duct | – Can follow instrumentation (e.g. endoscopic retrograde cholangio-pancreatography, ERCP)

Question 30

symptoms of cholangitis

Answer 30

– Fever (rigors), jaundice and right upper quadrant pain

Question 31

define pyogenic liver abcesss

Answer 31

collection of pus in liver.

Question 32

routes for infection which causes pyogenic liver abcesses

Answer 32

biliary obstruction, direct from intrabdominal infections, Haematogenous- from mesenteric infections via hepatic portal vein, from systemic intravascular infection- hepatic artery

Question 33

predisposing factors to intrarittoneal abcessess

Answer 33

``` – Perforation-Peptic ulcer, Perforated appendix, Perforated diverticulum – Cholecystitis – Mesenteric ischemia/bowel infarction – Pancreatitis/pancreatic necrosis – Penetrating trauma – Postoperative anastomotic leak ```

Question 34

common areas for intraperitoneal abcess to form

Answer 34

– Subphrenic, subhepatic, paracolic, pelvic

Question 35

symptoms of intrapertioneal abcess

Answer 35

non specific | Sweating, anorexia, wasting, High swinging pyrexia (high then low)

Question 36

symptoms of subphrenic abcess

Answer 36

– Pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly (liver displaced downwards, ipsilateral lung collapse with pleural effusion (collapse where ulcer is and effusion is due to blood)

Question 37

symptoms of a pelvic abcess

Answer 37

– Urinary frequency | – Tenesmus- need to release bowels.

Question 38

common aerobic bacteria gram -ve bacilli

Answer 38

E .coli

Question 39

common anaerobic bacteria gram -ve bacilli

Answer 39

Bacteroides

Question 40

common aerobic Gram-positive cocci

Answer 40

Enterococcus spp. | Occasionally milleri-group streptococci

Question 41

common anaerobic Gram-positive bacilli

Answer 41

clostrisium

Question 42

common features of liver abscesses.

Answer 42

polymicrobial

Question 43

what can cause a liver abcess

Answer 43

haematogenous spread or trauma may not involve normal GI flora Hepatobiliary tract infections usually involve lower GI flora, despite

Question 44

what blood investigations are carried out for intraabdominal infections

Answer 44

* Full blood count: neutrophilia/neutropenia * C-reactive protein: raised * Liver function tests: abnormal in hepatobiliary disease

Question 45

what is imaging used for intraabdominal infections and why is it used

Answer 45

``` Chest x-ray – Consolidation, pleural effusion adjacent to infected area (e.g. subphrenic abscess) Abdominal ultrasound – Abdominal masses – Free fluid – Dilated bile ducts Abdominal CT scan – Higher definition than ultrasound ```

Question 46

what microbiological investigations (excluding bloods) are carried out for intraabdominal infections

Answer 46

– Peritoneal fluid – Ultrasound/CT guided drainage fluid – Microscopy, culture and sensitivity testing

Question 47

most common treatment for Intraperitoneal abcess

Answer 47

drainage

Question 48

how are antibiotics used to treat intrabdominal abcesses

Answer 48

• Start smart …. – best guess(empirical) antibiotics. – Intestinal source- coliforms and anaerobes. o Cefuroxime & metronidazole (