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Year 2 Clinical Pathology > Intra-abdominal infections > Flashcards

Intra-abdominal infections Flashcards

1
Q

What is the definition of intra-abdominal infection?

A

Presence of micro-organisms in normally sterile sights within the abdominal cavity eg. the peritoneal cavity or hepatobiliary tree

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2
Q

Is gastro-enteritis an intra-abdominal infection?

A

No as the bowel lumen is a non sterile sight

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3
Q

Are normal flora found in the stomach?

A

No - the stomach is considered to be sterile

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4
Q

Why is the proximal small intestine relatively free of microorganisms, what few organisms are found?

A

Growth is inhibited by bile

A few aerobic bacteria and Candida spp

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5
Q

What is the flora of the small intestine?

A

Same as that of large intestine

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6
Q

The large intestine has mainly anaerobic bacteria, what 2 aerobic bacteria are also found?

A

1) Enterobacteriacae (enteric GNB, coliforms)

2) Gram-positive cocci (mainly enterococci)

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7
Q

What are the 3 main sources of intra-abdominal infection?

A

1) Gastrointestinal contents
2) Blood
3) External

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8
Q

What are the mechanisms of intra-abdominal infection, each is typical of what kind of infection?

A

1) Translocation of micro-organisms from GIT lumen to peritoneal cavity - intraperitoneal infections
2) Translocation of micro-organisms along a lumen - biliary tract/ hepatobiliary infections
3) Translocation of micro-organisms from an extra-intestinal source - penetrating trauma, haematogenous spread

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9
Q

What are the 3 possible reasons for translocation of organisms across a wall causing intra-abdominal infection?

A

1) Perforation - perforated appendix, perforated ulcer, perforated diverticulum, malignancy
2) Loss of wall integrity (not actually a perforation but still gets through) - ischaemia and strangulation
3) Surgery - seeding at operation, anastomotic leak

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10
Q

What are the 2 possible reasons for translocation along a lumen causing intra-abdominal infection?

A

1) Blockage - cholecystitis, cholangitis, hepatic abscess

2) Iatrogenic - instrumentation (eg. endoscopic retrograde cholangiopancreatography)

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11
Q

Perforated appendix is mainly a disease of what group of people?

A

Children and young adults

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12
Q

What is the main symptom of perforated appendix?

A

Severe, generalised pain

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13
Q

What condition can perforated appendix lead to?

A

Shock

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14
Q

How does a perforated appendix occur?

A

1) Lymphoid hyperplasia or faecal obstruction
2) Results in stagnation of luminal contents, bacterial growth and recruitment of inflammatory cells
3) Build up of intraluminal pressure may result in perforation
4) Escape of luminal contents into peritoneal cavity is peritonitis

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15
Q

Perforated appendix can localise to form what?

A

An appendix mass

Inflamed appendix with adherent covering of omentum and small bowel

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16
Q

What are diverticula?

A

Herniations of mucosa/submucosa through muscular layer in the sigmoid and descending colon

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17
Q

How common are asymptomatic diverticula?

A

50% in over 70 years

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18
Q

What are the 3 main complications of diverticula disease?

A

1) Diverticulitis
2) Perforation
3) Pericolic abscess

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19
Q

Is intraperitoneal or bloodstream infection a common complication of bowel cancer?

A

Intraperitoneal and/or bloodstream infection is an infrequent complication of bowel cancer

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20
Q

Bowel cancer is particularly associated with what 2 infections?

A

1) Clostridium septicum

2) Streptococcus gallolyticus (formerly S bovis) bloodstream infection

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21
Q

What is intra-abdominal infection in bowel cancer caused by?

A

Loss of bowel wall integrity due to abnormal malignant tissue

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22
Q

Why does ischaemia lead to translocation of bowel contents cause intra-abdominal infection?

A

1) Interruption of intestinal blood supply
eg. strangulation, arterial occlusion, post-operative (aneurysm repair)
2) Gut wall loses structural integrity
3) Allows translocation of luminal contents

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23
Q

What are the 2 symptoms of acute intra-abdominal infection?

A

1) Abdominal pain and tenderness

2) Shock

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24
Q

When does an intraperitoneal abscess commonly present?

A

A late complication - several months after pre-disposing factor

25
Q

What are the 2 main reasons for post-operative intra-abdominal infection?

A

1) Seeding at operation

2) Anastomotic leak

26
Q

How is the incidence of post operative infection through seeding at operation reduced?

A

Incidence reduced with bowel preparation/ prophylactic Abx

27
Q

Hepatobiliary infections are caused by what mechanism?

A

Translocation across a lumen

28
Q

What is cholecystitis?

A

Inflammation of the gall bladder wall

29
Q

Is bacterial infection always the cause of cholecytitis?

A

No, can be chemical inflammation

Bacterial infection may be the cause or result of cholecystitis

30
Q

What is cholecystitis associated with?

A

Obstruction of the cystic duct - gall stones or other causes such as malignancy, surgery, parasitic worms - very occasionally no obstruction

31
Q

What is emphysematous cholecystitis?

A

More severe, get intramural gas in gallbladder wall

32
Q

What are the 3 main parts of presentation of cholecystitis?

A

1) Fever
2) Right upper quadrant pain
3) Mild jaundice

33
Q

What is empyema of the gall bladder?

A

Frank pus in the gallbladder which is a complication of cholecystitis

34
Q

What are the 3 extra components to the presentation of empyema of the gall bladder in addition to those of cholecystitis?

A

1) Severe pain
2) High fever
3) Chills and rigors

35
Q

What is cholangitis?

A

Inflammation/infection of the biliary tree

36
Q

What is the cause of cholangitis?

A

Same as causes of cholecysitis - mainly obstruction of common bile duct, can follow instrumentation (eg. ERCP)

37
Q

What are the 3 main components of presentation of cholangitis?

A

1) Fever (rigors)
2) Jaundice
3) Right upper quadrant pain
Presentation may be non specific

38
Q

What are the 5 routes of infection causing pyogenic liver abscess?

A

1) Biliary obstruction
2) Direct spead from other intra-abdominal infections
3) Haematogenous - from mesenteric infection via hepatic portal vein, from systemic intravascular infection via hepatic artery
4) Penetrating trauma
5) Idiopathic

39
Q

What is an intra-peritoneal abscess, how are they classified?

A

Localised area of peritonitis with build-up of pus, classified according to anatomical sites eg. subphrenic, subhepatic, paracolic, pelvic etc.

40
Q

What are the 6 predisposing factors to intra-peritoneal abscess?

A

1) Perforation
2) Cholecystitis
3) Mesenteric ischaemia/bowel infarction
4) Pancreatitis/ pancreatic necrosis
5) Penetrating trauma
6) Postoperative anastomotic leak

41
Q

How does an intra-peritoneal abscess present?

A

Non specific presentation - sweating, anorexia, wasting, high swinging pyrexia

42
Q

What are the 5 clinical signs of a subphrenic abscess?

A

1) Pain in shoulder on affected side
2) Persistent hiccup
3) Intercostal tenderness
4) Apparent hepatomegaly (liver displaced downwards)
5) Ipsilateral lung collapse with pleural effusion

43
Q

What are the 2 main clinical signs of a pelvic abscess?

A

1) Urinary frequency

2) Tenesmus - a continual or recurrent urge to empty the bowels

44
Q

Amoebic abscesses are commonly caused by what bacteria?

A

Entamoeba histolytica

45
Q

A hyatid cyst is caused by what pathogen?

A

Echinococcus granulosus

46
Q

How is ileo-caecal TB commonly diagnosed?

A

By CT scan

47
Q

In what 2 abdominal organs, other than the liver can abscesses commonly occur?

A

Pancreatic and splenic abscesses

48
Q

What is spontaneous bacterial peritonitis?

A

Infected ascetic fluid but no obvious perforation or reason for the infection

49
Q

What are the 2 most common aerobic GNB found in the gut flora which causes intra-abdominal infection?

A

1) Enterobacteriacae - predominantly E.coli

2) Pseudomonas spp

50
Q

What are the 2 most common anaerobic GNB found in the gut flora which cause intra-abdominal infection?

A

1) Bacteroides spp

2) Prevotella spp

51
Q

What are the 2 most common aerobic GPC found in the gut flora which cause intra-abdominal infection?

A

1) Enterococcus spp

2) Milleri-group streptococci

52
Q

What is the main anaerobic GPB found in the gut flora which cause intra-abdominal infection?

A

clostridium spp

53
Q

What bacteria are liver abscesses commonly caused by, does it always involved normal GI flora?

A

Usually polymicrobial - may be sterile (hard to grow anaerobes)
Infections secondary to haematogenous spread or trauma may not involve normal GI flora

54
Q

Hepatobiliary tract infections usually involve flora from where?

A

Lower GI flora, despite duodenal origin

55
Q

What 3 blood tests are common in intra-peritoneal infection and what do they normally show?

A

1) FBC: neutrophils/neutropenia
2) CRP: raised
3) LFTs: abnormal in hepatobiliary disease

56
Q

What are 3 common imaging techniques in the diagnosis of intra-abdominal infection?

A

1) CXR - consolidation, pleural effusion adjacent to infected areas
2) Abdominal US - shows abd masses, free fluid, dilated bile ducts
3) Abdominal CT scan - higher definition that US

57
Q

What are the 3 common samples to test and 3 common procedures in microbiological investigations in intra-abdominal infection?

A

1) Blood
2) Peritoneal fluid
3) US/CT guided drainage fluid
-
1) Microscopy
2) Culture
3) Sensitivity testing

58
Q

What is the treatment for an intraperitoneal abscesses? 3

A

1) CT/US guided
2) Surgical (multiocular abscesses)
3) Combined with antimicrobial therapy

Year 2 Clinical Pathology (64 decks)

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