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19 Cards in this Set

  • Front
  • Back
RUQ tenderness means what?
Biliary process
LLQ tenderness means what?
diverticulitis, PID
RLQ tenderness means what?
appendicitis, PID
blood culture what type of patients?
very sick, high fever, chills
polymicrobial infections of the abdomen area?
2-3 or more gram -'s bacilli

if nonsocomial gram -
-p. aeruginosa

-bacteroides fragilis

-group d strep
Abx aimed at B. fragilis?
Clindamycin general
given orally unless ill then do IV

metabolized by liver
doesn't penetrate CSf but bond and tissue good.

adjust dose in hepatic failure

can use in children and pregnant women
Clindaymycin uses
excellent against GAS
good for MSSA not MRSA
no good for gram -
Anaerobes good but 5-10% of b. fragilis strains are resistant

if patient is really sick don't go with this one cause b. fragilis resistant strains exist.

intraabdominal infections:
+gentamycin to cover gram -'s
Clindaymycin toxicity
don't give to people with diarrhea because increased incidence of C.difficile diarhea with use of the drug.
Metronidazole is DOC for?
b. fragilis (anaerobe) and for anaerobes in intrabdominal infections
c. difficile diarrhea (orally)
Metronidazole general
avoid 1st trimester pregnancy last drug to chose for 2 and 3 trimester.
carinogenic potential
alcohol intolerance
gi upset with metallic taste
good bioavailability orally
excellent penetrance and csf too
reduce dose in renal failure
reduce dose in hepatic insufficiency
Metronidazole uses
no gram - coverage
E. histolytica, giardia, trichomas vaginalis (aka parasites)
b. fragilis
c. difficile
how do you go about treating intraabdominal infections?
treat for aerobic gram -'s and anaerobic (b. fragilis)
Other agents that have good activity against b. fragilis and gram - are?
1. ampicillin-sulbactam
2. ticarcillin-clavulante
3. piperacillin-tazobactum
4. 2nd gen cephalosporin called cefoxitin
5. Impenem cause its very broad

and as discussed
clindaymycin + gentamicin
metronidazole + cefazolin which is cost effective in community acquired infections.
Peritonitis diagnosis?
Increased peripheral WBC
abdominal x rays, flat and upright
blood cultures
amylase, lipase
CT not essential
Percussion tenderness
Intraabdominal abscess diagnosis?
fever chills with history of prior surgery
unexplained fever
increased ESR
blood culture may be positive
Biliary tract infections diagnosis?
RUQ pain variable tenderness
Acute cholecystitis is inflammation of the gall bladder secondary to obstruction
Acute cholanitis is more severe life threatening form. gall bladder functions as abscess.

Biliary ultrasound, CT scan

INCLUDE Coverage for enterococci on treatment
Diverticulitis diagnosis?
Colon diverticula are common.
Diverticulitis is a perforation of the fundus of the diverticulm and pericolic inflammation.

LLQ pain, tenderness, fever
GI bleeding usually not seen though stool can be trace +
increased WBC and ESR

CT scan test of choice
Pancreatitis diagnosis?
Upper adbominal pain, fever, increased WBC

Abdomincal CT scan again