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19 Cards in this Set
- Front
- Back
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RUQ tenderness means what?
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Biliary process
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LLQ tenderness means what?
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diverticulitis, PID
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RLQ tenderness means what?
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appendicitis, PID
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blood culture what type of patients?
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very sick, high fever, chills
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polymicrobial infections of the abdomen area?
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2-3 or more gram -'s bacilli
-e.coli -klebsiella if nonsocomial gram - -p. aeruginosa -enterobacter anaerobes -bacteroides fragilis enterococci -group d strep |
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Abx aimed at B. fragilis?
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Clindamycin
Metronidazole |
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Clindamycin general
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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 |
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Clindaymycin uses
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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 |
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Clindaymycin toxicity
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don't give to people with diarrhea because increased incidence of C.difficile diarhea with use of the drug.
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Metronidazole is DOC for?
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b. fragilis (anaerobe) and for anaerobes in intrabdominal infections
c. difficile diarrhea (orally) |
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Metronidazole general
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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 |
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Metronidazole uses
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no gram - coverage
E. histolytica, giardia, trichomas vaginalis (aka parasites) b. fragilis c. difficile |
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how do you go about treating intraabdominal infections?
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treat for aerobic gram -'s and anaerobic (b. fragilis)
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Other agents that have good activity against b. fragilis and gram - are?
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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 and metronidazole + cefazolin which is cost effective in community acquired infections. |
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Peritonitis diagnosis?
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Increased peripheral WBC
abdominal x rays, flat and upright blood cultures amylase, lipase CT not essential Percussion tenderness fever |
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Intraabdominal abscess diagnosis?
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fever chills with history of prior surgery
unexplained fever leukocytosis increased ESR blood culture may be positive CT SCAN BEST! |
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Biliary tract infections diagnosis?
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RUQ pain variable tenderness
fever 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 |
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Diverticulitis diagnosis?
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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 NO ENDOSCOPY CT scan test of choice |
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Pancreatitis diagnosis?
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Upper adbominal pain, fever, increased WBC
Abdomincal CT scan again |
