SM_166b: Infectious Diseases of the Luminal GI Tract Flashcards
Primary peritonitis (spontaneous bacterial peritonitis) is ____
Primary peritonitis (spontaneous bacterial peritonitis) is bacterial perotinitis without an inciting event and virtually always occurs in the setting of ascites
Secondary peritonitis is ____
Secondary peritonitis is bacterial contamination of the peritoneum as a result of spillage of intestinal flora
Intraperitoneal abscess is ____
Intraperitoneal abscess is localized / confined (walled off) infection within the peritoneal space
Visceral abscess is ____
Visceral abscess is localized infection within an organ
Primary peritonitis (spontaneous bacterial peritonitis) nearly always develops after ___
Primary peritonitis (spontaneous bacterial peritonitis) nearly always develops after ascites
- Cirrhosis with ascites: 10% develop primary peritonitis
- Monomicrobial etiology: E. coli. Klebsiella, Streptococcus penumoniae, Enterococci, rarely anaerobes, others

Primary peritonitis routes of infection are ____, ____, ____, and ____
Primary peritonitis routes of infection are hematogenous, lymphatogenous, translocation, and from vagina via fallopian tubes in women
Primary peritonitis pathogenesis involves cirrhosis-related ____ consisting of ____ and ____
Primary peritonitis pathogenesis involves cirrhosis-related immune deficiency consisting of serum / ascitic fluid complement deficiency and neutrophil dysfunction
Describe clinical manifestations of primary peritonitis
Primary peritonitis clinical manifestations
- Symptoms: fever, abdominal pain, nausea, vomiting, diarrhea
- Signs: diffuse abdominal tenderness, rebound tenderness, hypoactive / absent bowel sounds
- Cirrhotic patients: progressive encephalopathy, hepatorenal syndrome
Primary perotonitis paracentesis shows ____ and ____
Primary perotonitis paracentesis shows increased neutrophils and monomicrobial infection
- Ascitic fluid neutrophil counts: > 250/mm3
- Cultures may be sterile in up to 35% of cases
Primary peritonitis antibiotic therapy is focused on ____
Primary peritonitis antibiotic therapy is focused on aerobic gram-negative bacilli
Secondary peritonitis is ____ due to ____
Secondary peritonitis is spillage of GI or GU microorganisms into the peritoneal cavity due to loss of integrity of the mucosal barrier
- Perforation of appendicitis, diverticulitis, peptic ulcer, intestinal neoplasm
- Traumatic perforation of bowel, uterus, bladder
- Gangrene of bowel secondary to strangulation, bowel obstruction, or mesenteric vascular obstruction
Secondary peritonitis etiology includes ____
Secondary peritonitis etiology includes endogenous intestinal microorganisms (polymicrobial)
- Typical infection associated with bowel perforation averages 4.5 organisms (2.5 anaerobes, 2 aerobes)

Describe pathogenesis of secondary peritonitis
Secondary peritonitis pathogenesis
- Chemical peritonitis (bile, gastric fluid, pancreatic secretions): increases susceptibility to infection by small numbers of contaminating bacteria
- Risk of infection increases with microbial load: stomach < small intestine < colon
- Local response: localized abscess or diffuse peritonitis
- Systemic response: ileus, sepsis / septic shock
Describe clinical manifestations of secondary peritonitis
Secondary peritonitis clinical manifestations
- Symptoms: abdominal pain, fever, shaking chills, anorexia, nausea, vomiting
Signs: lies quietly with knees flexed, tachycardia, rapid shallow breathing, marked abdominal tenderness, rebound tenderness, abdominal wall rigidity, hypoactive or silent bowel sounds
Secondary peritonitis paracentesis demonstrates ____
Secondary peritonitis paracentesis demonstrates elevated WBC count with a left shift
- Abdominal X-rays: ileus
- Chest X-ray: free air
- Abdominal CT scan: peritoneal fluid collections, intra-abdominal abscess
- Needle aspiration of the peritoneal space

Secondary peritonitis treatment involves ____, ____, or ____
Secondary peritonitis treatment involves broad-spectrum antibiotics, surgery, or percutaneous drainage of localized fluid collections
Secondary bacterial peritonitis in the presence of ascites mortality is ____ if treated only with antibiotics and without surgery
Secondary bacterial peritonitis in the presence of ascites mortality is 100% if treated only with antibiotics and without surgery
- Mortality is high even with surgery
Primary peritonitis and unncessary exploratory laparotomy leads to ____
Primary peritonitis and unncessary exploratory laparotomy leads to 80% mortality
Continuous ambulatory peritoneal dialysis peritonitis pathogenesis involves ____ and ____
Continuous ambulatory peritoneal dialysis peritonitis pathogenesis involves contamination of the catheter by skin organisms and relapsing / recurrent peritonitis via biofilms
- Staphylococcus epidermidis and Staphylococcus aureus

Continuous ambulatory peritoneal dialysis peritonitis presents with ____
Continuous ambulatory peritoneal dialysis peritonitis presents with abdominal pain and cloudy dialysate
Continuous ambulatory peritoneal dialysis peritonitis treatment involves ____
Continuous ambulatory peritoneal dialysis peritonitis treatment involves antibiotics via dialysate
- May also need catheter removal
Intraperitoneal abscess is ____ due to ____
Intraperitoneal abscess is infection with viable organisms and neutrophils within a fibrous capsule due to host response confining the infection to a limited space
____ is the main pathogen implicated in intraperitoneal abscess though infection is often polymicrobial
Bacteroides fragilis is the main pathogen implicated in intraperitoneal abscess though infection is often polymicrobial
- Cell surface capsular polysaccharide complex is an important virulence factor
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