Shared Flashcard Set

Details

IAI 1st half 516 ID dumb down
intra - abdominal infections (SBP only)
25
Medical
Professional
03/26/2009

Additional Medical Flashcards

 


 

Cards

Term
What organ or organ parts are contained in the retroperitoneal space?
Definition
duodenum, pancreas, kidneys, and adrenal glands
Term
What organ or organ parts are located in the peritoneal cavity?
Definition
appendix, ileum/jejunum, large bowel, liver, gall bladder, spleen, uterus, fallopian tubes, and ovaries
Term
What are the 3 general ways that a host may respond to pathogen breach of the peritoneum?
Definition
clear bacteria, form abscess, peritonitis
Term
What is the mortality range for peritonitis (all 4 classifications)?
Definition
10 - 60%
Term
What is another name for spontaneous bacterial peritonitis (SBP)?
Definition
primary peritonitis
Term
What is another name for primary peritonitis?
Definition
spontaneous bacterial peritonitis (SBP)
Term
What are the general classifications of intra - abdominal infections?
Definition
primary peritonitis, secondary peritonitis, tertiary peritonitis, peritonitis complicating peritoneal dialysis (PD)
Term
Most cases of ascites occur due what?
Definition
alcoholic cirrhosis
Term
What are some causes of ascites other than alcoholic cirrhosis?
Definition
SCANNC - SLE, CHF, Acute viral hepatitis, Necrotic cirrhosis, Nephrotic syndrome, Chronic active hepatitis
Term
What is the leading theory of how primary peritonitis develops?
Definition
hematogenous spread
Term
What is the mortality rate of SBP today?
Definition
10 - 30%
Term
Primary peritonitis develops in what percentage of patients with cirrhosis?
Definition
10 - 30%
Term
Aside from ascites what are the predisposing factors for developing primary peritonitis?
Definition
CHUBBI P's - CHild - Pugh class C, UTI, T Bili > 2.5 mg / dL, gi Bleeding, Intravascular catheters, Previous SBP, ascitic fluid total Proein < 1 g / dL
Term
What symptoms develop as SBP progresses?
Definition
FALDA - Fever (~ 70%), Abdominal pain / tenderness (50 - 60%), Leukocytosis, Diarrhea, Altered mental status (50 - 60%)
Term
What is the gold standard for SBP diagnosis?
Definition
paracentesis
Term
What tests are done on ascitic fluid obtained during paracentesis?
Definition
Gram stain, culture, WBCs
Term
What is the PMN diagnostic cutoff to start antibiotics if not already started for SBP?
Definition
> 250 / mL
Term
How is PMN count corrected if traumatic tap occurs during paracentesis?
Definition
subtract "1" PMN for every "250" RBCs in ascitic fluid
Term
What are the typical causative organisms of SBP?
Definition
60 - 70% Gram neg. enteric bacteria (E.coli, Klebsiella pneumo.), ~ 25% Gram pos. cocci (usually Streptococcus, 2 - 4% Staph. aureus), very rarely anaerobes / polymicrobial
Term
What are the standard empiric therapies for SBP?
Definition
Cefotaxime 2g IV Q8H, ceftriaxone 2g IV Q24H
Term
What are the SBP choices for empiric therapy when resistant / ESBL producing organism is suspected?
Definition
1st choice is Carbapenems (imipenem, meropenem, doripenem), FQs (cipro-, levo-, moxi-, likely cross-resistant if ESBL), penicillin allergic (aztreonam, likely cross-resistant if ESBL producing)
Term
What route of administration is almost always required for SBP? Why?
Definition
Parenteral - patients usually critically ill; often with GI bleed or ileus, need to cover Strep. and gram negatives, need high concentrations in ascitic fluid
Term
What is the duration of therapy for SBP?
Definition
5 days, 14 days if blood cultures are positive
Term
What specific groups of cirrhotic patients are shown to benefit from SBP prophylaxis?
Definition
GI bleed, previous SBP, ascitic fluid albumin < 1g / dL
Term
What are the SBP prophylaxis regimens?
Definition
GI bleed norfloxacin 400 mg PO Q12H X7 days, previous SBP (until resolution of ascites / transplant) & AF albumin < 1g / dL (during hospitalization) - cipro 750 mg PO QW; Bactrim DS PO QD X5 days / week; norfloxacin 400 mg PO QD
Supporting users have an ad free experience!