May11 M2-Intraabdominal Infections

Question 1

(EXAM) what’s infection

Answer 1

A PROCESS. bacteria invade normally sterile host tissues

Question 2

(EXAM) what’s sepsis

Answer 2

RESPONSE to infection. pyrexia, tachypnea, tachycardia, hypoxia, hypermetabolism, ORGAN DYSFUNCTION

Question 3

(important) SIRS criteria and one thing that is NOT there

Answer 3

• temp>38 or <36
• HR>90
• PCO2<32 or RR>20
• WBCs >12000 or <4000 or bands>10% (some sort of inflammation)
• bacteria is not a criterion*

Question 4

(imp?) important concepts in sepsis

Answer 4

• primary cause of death in infections. needs urgent attention
• syndrome shaped by pathogen factors AND HOST factors (sex, race, age, genetics)
• organ dysfunction may be occult (consider it in any patient)
• previous or present illness can modify how sepsis appears
• can have only LOCAL organ dysfunction (TEMPERED SEPSIS**)

Question 5

(EXAM) 2 critical pathophysiologic events in sepsis

Answer 5

1. decreased peripheral vascular resistance (PVR):
   - permeable (leaky) capillaries
   - hypotension
   * fluid given will leak out*
2. decreased oxygen extraction:
   - metabolic acidosis
   - cellular damage (cell so sick can’t take O2)

Question 6

most common model virulence factor used in sepsis

Answer 6

LPS (is a gram- sepsis model)

Question 7

(imp?) time for the organ dysfunction to happen in sepsis

Answer 7

can go from 0 organ dysfunction to 3 organs not functioning VERY quickly.

Question 8

key cytokines in sepsis

Answer 8

TNF-a and IL-1. lead to protease release and activation.

all cells produce pro and anti-inflam cytokines

Question 9

(imp?) important blood component involved in sepsis

Answer 9

coagulation system

• APC (activated protein C) is anti-inflammatory, anti thrombotic, anti-many bad things
• APC is depleted in infection
• get blockages in very small blood vessels, reduing O2 delivery

Question 10

(imp?) reason why you get organ dysfunction in sepsis

Answer 10

microcirculatory dysfunction because of the clots blocking microcirculation

Question 11

3 criteria of organ failure assessment in sepsis

Answer 11

• RR
• BP
• Glasgow coma score

Question 12

principles of adequate sepsis management

Answer 12

1. send culture then early Abx
2. 30 cc fluids per kg (crystalloid like NS first. albumin the rest). blood if Hb < 70
3. NE, E and dopamine. ADH if not resp to any.
4. steroids if no resp to fluids and vasopressors

Question 13

main goal in septic shock management

Answer 13

increase O2 delivery to the tissues

Question 14

other important things to give in sepsis

Answer 14

maintain the basics needed for proper metabolism

• control the hyperglycemia (is bad)
• Ca
• T4 (thyroxine)
• hydrocortisone

Question 15

uncomplicated vs complicated intra-abd infections

Answer 15

complicated = extends to peritoneal cavity or normally sterile region of the abdomen

Question 16

primary vs secondary vs tertiary peritonitis

Answer 16

primary = infection with no break, irritation
secondary = inflam + hole somewhere
tertiary = persistent or recurrent infection bc treatment (like surgery) didn't do 100% source control

Question 17

key concept in intra-abd infections management

Answer 17

source control (fix holes, surgery, etc.)

Question 18

very common surgical emergency and cause of intra-abd infections

Answer 18

appendicitis

Question 19

how appendicitis should be diagnosed

Answer 19

• clinical crieteria (tables exist for that). at least clinical criteria in peds.
• adults = CTs done sometimes

Question 20

why 1 in 3 patients have complications from appendectomies

Answer 20

because of their comorbidities (diabetics, heart problems, vasculopaths, etc.)

Question 21

tx of perforated appendicitis

Answer 21

Abx alone

Question 22

Abx for uncomplicated appendicits good and bad

Answer 22

• 1 in 5 pts won’t resolve with IV Abx for 3 days (so will need appendectomy)
• less complications with just Abx
• even if they come back, still treatable with Abx and it’s fine

Question 23

what organisms cause mortality in intra-abdominal infections (IAIs)

Answer 23

gram negatives

• E.coli
• Enterobacter
• Klebsiella
• Pseudomonas

Question 24

why some patients get a necrotizing infection that is complicated, need ventilator, have pulmonary edema and some will heal, breathing on room air with not many problems

Answer 24

genetic variations between individuals

single nucleotide polymorphisms are the most common variants