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Surgery > Surgical Infections > Flashcards

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?

A

Furuncle

25
Q

What are tx of Furuncle?

A

drainage at most fluctuant part (yellow area)
surgical area

26
Q

What is a group of clustered furuncles that have several openings? These are commonly seen in diabetic px?

A

Carbuncle

27
Q

What are tx of Carbuncle?

A

Cruciate incision (X-shaped incision)
Drain the debris

28
Q

what type of skin infection causes infection of sweat glands?

A

Hidradenitis Suppurativa

29
Q

What are tx of Hidradenitis Suppurativa?

A
  • initially managed conservatively w/ topical combination of antibiotic ointment (steroids)
  • oral antibiotics
  • drainage, excision
30
Q

What are the grades of Infected sacral ulcer/bed sores?

A

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
Q

What are the diff types of hand infections?

A

Cellulitis
Abscess
Flexor tenosynovitis
Felon
Paronychia

32
Q

What organism can cause an acute infection of the foot in diabetic px?

A

S aureus

33
Q

What indicates P aeruginosa as CA of chronic infection of diabetic foot infections?

A

Greenish discharge w/ fruity semell

34
Q

What are complications of diabetic foot infections?

A

Osteomyelitis
Altered foot architecture

35
Q

Wht are tx for diabetic foot infections?

A

Limb amputation
Foot care, offliading
wound care
debridement
disarticulation/ray amputation -> metatarsal head

36
Q

What is the tx for MRSA in severe soft tissue infections?

A

Vancomycin

37
Q

What is the tx for Strep pyogenes in severe soft tissue infections?

A

Penicillin + Clindamycin

38
Q

What is the tx for Clostridium spp in severe soft tissue infections?

A

Penicillin + Clindamycin

39
Q

What is the tx for Gram (-) in severe soft tissue infections?

A

Piperacilin-tazobactam

40
Q

What is the tx for Anaerobes in severe soft tissue infections?

A

Cabapenem

41
Q

What are diff postoperative nosocomial infections?

A

Surgical site infections
Pneumonia
Bloodstream infections
UTI

42
Q

What are the 2 types of surgical site of infection?

A
  1. Incisional infection - skin & deep layers
  2. Organ/space infection - adjacent organ/space where organ is removed
43
Q

what are risk factors for developing surgical site infection (SS))?

A

ASA score >3 (underlying illness)
Age
Obesity
Smoking
Wound classification

44
Q

What are the wound classes of SSI (!-IV)?

A

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
Q

At what class of wound is antibiotic prophylaxis given?

A

Class II wounds

46
Q

What is the ASA score of physical status score (ASA 1-6)?

A

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
Q

What is used to predict infection rate?

A

National Nosocomial Infection Surveillance System (NNIS) Risk Index for SSI

48
Q

What are the risk factors for NNIS scoring?

A

ASA score
type of wound
duration of surgery

49
Q

What are the CDC criteria for superficial incisional SSI?

A
  • occurs within 30days of surgery
  • prosthesis or implant up to 1 yr after surgery
50
Q

What are the prevention of SSI?

A

Preoperative phase
Intraoperative phase
Postoperative phase

51
Q

what are the things done in the preoperative phase?

A
  • preoperative shower
  • hair removal
    px & staff wear
  • staff movement
  • nasal decontamination
  • hand jewelry
  • mechanical bowel prep
  • antibiotic prophylaxis
52
Q

What types of px do u give antibiotic prophylaxis?

A
  • clean surgery w/ presthesis or impant
  • clean-contaminated surgery
  • contaminated surgery
53
Q

what are the things done in the intraoperative phase?

A

hand decontamination
incise drapes (disposable)
use of sterile gowns
gloves
antiseptic skin prep
Electrocautery
Miantaning px homeostasis
Wound irrigation & intracavitary lavage
Wound dressing

54
Q

What are the things done in the postoperative phase?

A

Change of dressings
Postoperative cleansing
Dressings for wound healing by secondary intention
Antibiotic tx of SSI & tx failure
Debridement

55
Q

What are other infections caused by wound infecitons?

A

Typhoid
Amoebic liver abscess
Tetanus
Rabies

56
Q

What are the risk of exposure categories to Rabies?

A

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
Q

What are 3 types of antibiotics given for surveillance?

A

restricted
monitored
switch therapy

Surgery (4 decks)

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