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IOS 10 Exam 3
Intra-abdominal infections
| Question | Answer |
|---|---|
| Epidemiology of Primary peritonitis-Spontaneous bacterial peritonitis | An infection of the peritoney cavity without an evident source in the abdomen 40-70% of Alcoholics have recurrent SBP |
| Epidemiology of Secondary peritonitis | May involve perforation of the GI tract becuase of ulceration, ischemia, or obstruction, postoperative or post trauma |
| Pathogenesis theories of bacterial peritonitis | Hematogenous spread, lymphatic disruption, Impairment of bactericidal activity by alteration of peritoneal defenses |
| Patients at risk for intra-abdominal infection | Ascities, Cirrhosis, chronic liver disease, CHF, metastatic malignat disease, SLE, lymphedema |
| Recurrent SBP risk | Previous SBP 40-70%, Low ascitic fluid, GI bleed, Severity of liver disease |
| C. Diff risk | Recent antibiotic use, Advanced age, immunocompromised conditions, serious underlying illiness, long length of stay in healthcare, Gi surgery or manipulation |
| Clinical presentation of primary SBP | Acute febrile illiness, abdominal pain, N/V, guarding, leukocytosis, hemodynamic istability, develops over days to weeks |
| Diagnosis of primary bacterial peritonitis | peritoneal tap of ascitic fluid will show elevation of neutrophils, protein, LDH, and if cultured bacteria (E.coli- Gram-) |
| Clinical presentation of C. diff | Lower abdominal cramps, diffuse or non-specific colitis, fever, nausea, anorexia, abdomial distension, profuse diarrheam fecal leukocytosis hemodynamic instability |
| Diagnosis of C. diff | Clinical suspecion can be enough |
| Most common cause of intra- abdominal infections in Children is | S. pneumonia, and Group A Strep (Gram+) |
| Most common cause of intra- abdominal infections in adults | E Coli, S. Pneumoniae, Strep spp |
| Goals of therapy for an intraabdominal infection | Eradicate the infecting pathogen, reduce the risk of recurrent infection, shorten the clinical manifestations |
| Spontaneous bacterial pertonitis should have activity against | Gram- bacteria (3rd gen Cephalosporins, B-lactam/b-lactamase inhibitors, fluoroquinolones) |
| Duration of treatment for intra-abdominal therapy | 5-10 days response usually seen in 24-48 hours |
| Primary treatment of SBP | Cefotaxime or ceftriaxone, Zosyn, Fluoroquinolone,(5-10d) + ALbumin 1.5g/d for day 1 and 3 |
| Primary Prophylaxis of SBP | Fluoroquinolone 7 days |
| Secondary prophylaxis Hx of SBP | TMP/SMX for 5 days of week for remainder of symptoms of risk |
| Treatment of secondary SPB | Gentamicin (resolves infection) + Clindamycin (stops abcess) |
| Treatment of intra-abdominal abscess | Gentamycin +metronadizole for 5-7 days and drain the abcess |
| C. difficeal secretes | Toxin A and enterotoxin that causes loss of function and decrease of absorption in the colon, and Toxin B-Cytoxin that kills the cell |
| C. diff infection goals | Isolate the patient,educate the HC workers, avoid antidiarrheals, fluid replacement is a must |
| drug of choice for C. diff infections is | Metronadizaole 250mg QID or 500mg TID second line is vancomycin 125-500mf PO QID duration is 7-10 days |
| Supplement therapy in C. diff treatment | Cholestyramine, probiotics (lactobacillus, Saccharomyces) |
| Recurrent C. Diff | Vancomycin + - rifampin 7 days |
Created by:
liza001
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