May11 M2-Intraabdominal Infections Flashcards
(EXAM) what’s infection
A PROCESS. bacteria invade normally sterile host tissues
(EXAM) what’s sepsis
RESPONSE to infection. pyrexia, tachypnea, tachycardia, hypoxia, hypermetabolism, ORGAN DYSFUNCTION
(important) SIRS criteria and one thing that is NOT there
- 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*
(imp?) important concepts in sepsis
- 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**)
(EXAM) 2 critical pathophysiologic events in sepsis
- decreased peripheral vascular resistance (PVR):
- permeable (leaky) capillaries
- hypotension
* fluid given will leak out* - decreased oxygen extraction:
- metabolic acidosis
- cellular damage (cell so sick can’t take O2)
most common model virulence factor used in sepsis
LPS (is a gram- sepsis model)
(imp?) time for the organ dysfunction to happen in sepsis
can go from 0 organ dysfunction to 3 organs not functioning VERY quickly.
key cytokines in sepsis
TNF-a and IL-1. lead to protease release and activation.
all cells produce pro and anti-inflam cytokines
(imp?) important blood component involved in sepsis
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
(imp?) reason why you get organ dysfunction in sepsis
microcirculatory dysfunction because of the clots blocking microcirculation
3 criteria of organ failure assessment in sepsis
- RR
- BP
- Glasgow coma score
principles of adequate sepsis management
- send culture then early Abx
- 30 cc fluids per kg (crystalloid like NS first. albumin the rest). blood if Hb < 70
- NE, E and dopamine. ADH if not resp to any.
- steroids if no resp to fluids and vasopressors
main goal in septic shock management
increase O2 delivery to the tissues
other important things to give in sepsis
maintain the basics needed for proper metabolism
- control the hyperglycemia (is bad)
- Ca
- T4 (thyroxine)
- hydrocortisone
uncomplicated vs complicated intra-abd infections
complicated = extends to peritoneal cavity or normally sterile region of the abdomen
primary vs secondary vs tertiary peritonitis
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
key concept in intra-abd infections management
source control (fix holes, surgery, etc.)
very common surgical emergency and cause of intra-abd infections
appendicitis
how appendicitis should be diagnosed
- clinical crieteria (tables exist for that). at least clinical criteria in peds.
- adults = CTs done sometimes
why 1 in 3 patients have complications from appendectomies
because of their comorbidities (diabetics, heart problems, vasculopaths, etc.)
tx of perforated appendicitis
Abx alone
Abx for uncomplicated appendicits good and bad
- 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
what organisms cause mortality in intra-abdominal infections (IAIs)
gram negatives
- E.coli
- Enterobacter
- Klebsiella
- Pseudomonas
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
genetic variations between individuals
single nucleotide polymorphisms are the most common variants
