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Surgical Infections Flashcards

1
Q

What conditions are present that inhibit patients’ full recovery from infections?

A
  1. persistent inflammation
  2. progressive immunosuppression
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2
Q

What are possible outcomes of microbial interaction w/ hosts in infections?

A

Eradication
Containment
Locoregional infection
Systemic infection - SIRS, MODS, MOF, PICS, sepsis

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3
Q

What are the criteria for SIRS?

A

General: fever, hypothermia, tachcycardia, tachypnea, altered mental status, hyperglycemia, edema

Inflammatory: leukocytosis, leukopenia, bendemia

Hypotension
Hypoxemia, oliguria, INC creatinine
INC lactate, DEC capillary refill

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4
Q

What are the diff ways to prevent infections?

A

Mechanical
Chemical
Physiologic - blood sugar control, temp control, tissue oxygenation
Antimicrobial prophylaxis

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5
Q

What are diff ways to control the source of infection?

A

drainage of purulent material
removal of infected or necrotic tissue
removal of foreign bodies
control of source of continuing contam/infection

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6
Q

What antibiotics are given for Gram + anaerobes, Gram - organisms, Anaerobic infection?

A

Gram (+) anaerboes = Clindamycin
Gram (-) = 2nd & 3rd gen Cephalosporins
Anaeorbic = Metronidazole, 3rd gen Cephalosporins

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7
Q

What type of intra-abdominal infection caused by non-surgical condition?

A

Primary microbial peritonitis

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8
Q

What are sources of primary microbial peritonitis?

A
  1. spread through direct inoculation
  2. hematogenous spread from a distant site
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9
Q

Wat is a treatment used in px w/ hydrocephalus or INC ICP that causes a complication in intrabdominal site?

A

ventriculoperitoneal shunt

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10
Q

What type of infection occurs to contamination of the peritoneal cavity due to perforation or severe inflammation?

A

Secondary microbial peritonitis

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11
Q

What are the causative agents of secondary microbial peritonitis?

A

Gram (-) enteric organisms & Anaerobes

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12
Q

What is the tx for secondary microbial peritonitis?

A
  • Surgical removal or resection of the infected organ
  • Px in whom std therapy fails typically develop one or more than an intra-abdominal abscess & leakage of GI anastomosis
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13
Q

What is the most common surgical condition?

A

Acute appendicitis

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14
Q

What are the stages of acute appendicitis?

A

Congestive (early) -> Suppurative –> gangrenous –> perforated or ruptured –> abscess/extensive peritonitis

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15
Q

What are the stages of prevention of SSI (surgical site infection)?

A

Chemical: skin prep w/ Iodine-based soln
Mechanical: sterile drapes, gowns gloves, appropriate PPE
Antibiotic prophylaxis: early stage appendicitis

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16
Q

What causes obstructing gallsone? PE?

A

Cause: Obstructing gallstone
PE: (+) Murphy’s sign

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17
Q

What are tx for acute cholecystitis?

A

Cholecystectomy
Antibiotics

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18
Q

What are symptoms of Acute Cholecystitis?

A

RUQ pain
Vomiting & fever
Fatty food intolerance

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19
Q

What type of hepatic abscess accounts majority of hepatic abscesses?

A

Pyogenic abscess

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20
Q

What causes Pyogenic abscess? Organisms?

A

biliary tract manipulation

E. coli, Klebsiella, other Gram (-) enteric bacteria, Pseudomonas, Bacteroides, Candida

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21
Q

What are tx of Pyogenic abscess?

A

Drainage
Antibiotics 4-6 wks

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22
Q

What is the most common type of abscess seeni n low & middle income countries? Tx?

A

Amoebic abscess
Tx: Metronidazole & Drainage

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23
Q

what are the diff skin & soft tissue infections?

A

Furuncle
Carbuncle
Hidradenitis suppurativa
Hand infections
Infected sacral ulcer/Bed sores
Diabetic foot infections

24
Q

What is a localized skin infection w/ pus with erythema?

25
What are tx of Furuncle?
drainage at most fluctuant part (yellow area) surgical area
26
What is a group of clustered furuncles that have several openings? These are commonly seen in diabetic px?
Carbuncle
27
What are tx of Carbuncle?
Cruciate incision (X-shaped incision) Drain the debris
28
what type of skin infection causes infection of sweat glands?
Hidradenitis Suppurativa
29
What are tx of Hidradenitis Suppurativa?
- initially managed conservatively w/ topical combination of antibiotic ointment (steroids) - oral antibiotics - drainage, excision
30
What are the grades of Infected sacral ulcer/bed sores?
Grade 1 = Supeerficial; relieve pressure to prevent progression Grade 2 = subcutaneous tissue; wound care Grade 3: muscles & fascia: go to OR take out necrotic area Grade 4: muscles & fascia; more extensive debridement
31
What are the diff types of hand infections?
Cellulitis Abscess Flexor tenosynovitis Felon Paronychia
32
What organism can cause an acute infection of the foot in diabetic px?
S aureus
33
What indicates P aeruginosa as CA of chronic infection of diabetic foot infections?
Greenish discharge w/ fruity semell
34
What are complications of diabetic foot infections?
Osteomyelitis Altered foot architecture
35
Wht are tx for diabetic foot infections?
Limb amputation Foot care, offliading wound care debridement disarticulation/ray amputation -> metatarsal head
36
What is the tx for MRSA in severe soft tissue infections?
Vancomycin
37
What is the tx for Strep pyogenes in severe soft tissue infections?
Penicillin + Clindamycin
38
What is the tx for Clostridium spp in severe soft tissue infections?
Penicillin + Clindamycin
39
What is the tx for Gram (-) in severe soft tissue infections?
Piperacilin-tazobactam
40
What is the tx for Anaerobes in severe soft tissue infections?
Cabapenem
41
What are diff postoperative nosocomial infections?
Surgical site infections Pneumonia Bloodstream infections UTI
42
What are the 2 types of surgical site of infection?
1. Incisional infection - skin & deep layers 2. Organ/space infection - adjacent organ/space where organ is removed
43
what are risk factors for developing surgical site infection (SS))?
ASA score >3 (underlying illness) Age Obesity Smoking Wound classification
44
What are the wound classes of SSI (!-IV)?
Class I (clean) - hernia repair, breast biopsy spx Class II (Clean/conam) - cholecystectomy, elective GI surgery Class III (contaminated) - large tissue injury Class IV (dirty) - perforate diverticulosis
45
At what class of wound is antibiotic prophylaxis given?
Class II wounds
46
What is the ASA score of physical status score (ASA 1-6)?
ASA 1 = normal healthy px ASA 2 = mild systemic disease ASA 3 = severe systemic disease ASA 4 = severe systemic dis, constant threat to life ASA 5 = moribound px, w/o operation ASA 6 = declared brain-dead px
47
What is used to predict infection rate?
National Nosocomial Infection Surveillance System (NNIS) Risk Index for SSI
48
What are the risk factors for NNIS scoring?
ASA score type of wound duration of surgery
49
What are the CDC criteria for superficial incisional SSI?
- occurs within 30days of surgery - prosthesis or implant up to 1 yr after surgery
50
What are the prevention of SSI?
Preoperative phase Intraoperative phase Postoperative phase
51
what are the things done in the preoperative phase?
- preoperative shower - hair removal px & staff wear - staff movement - nasal decontamination - hand jewelry - mechanical bowel prep - antibiotic prophylaxis
52
What types of px do u give antibiotic prophylaxis?
- clean surgery w/ presthesis or impant - clean-contaminated surgery - contaminated surgery
53
what are the things done in the intraoperative phase?
hand decontamination incise drapes (disposable) use of sterile gowns gloves antiseptic skin prep Electrocautery Miantaning px homeostasis Wound irrigation & intracavitary lavage Wound dressing
54
What are the things done in the postoperative phase?
Change of dressings Postoperative cleansing Dressings for wound healing by secondary intention Antibiotic tx of SSI & tx failure Debridement
55
What are other infections caused by wound infecitons?
Typhoid Amoebic liver abscess Tetanus Rabies
56
What are the risk of exposure categories to Rabies?
Category I - most benign, touching/feeding animal; licking on intact skin Category I - px needs to be vax; nibbling uncovered skin; minor scratches/abrasions Category III = transdermal bites, licking of mucuous membranes
57
What are 3 types of antibiotics given for surveillance?
restricted monitored switch therapy

Surgery (4 decks)

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