Term
| What are the six organs of the peritoneal cavity? |
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Definition
Stomach
Large Bowel
Smal Bowel
Liver
Gallbladder
Spleen |
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Term
| What are the 6 things found in the retroperitoneal cavity? |
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Definition
Duodenum
Pancreas
Kidneys
Adrenal Glands
Aorta and vena cava
Most mesenteric vascular structures |
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Term
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Definition
| Purulent collection of fluid separated from the surrounding tissue by a wall of inflammatory cells and adjacent organs. |
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Term
| What are the three main causes of Primary Peritonitis? |
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Definition
Spontaneous bacterial peritonitis is an infection without an evident cause. It's generally caused by:
Peritoneal dialysis
Cirrhosis with ascites
Nephrotic syndrome |
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Term
| In general, how many organisms are involved in primary peritonitis? |
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Definition
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Term
| If your primary peritonitis is caused by cirrhosis, what is the most likely pathogen? |
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Definition
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Term
| If your primary peritonitis is caused by peritoneal dialysis, what is the most likely pathogen? |
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Definition
| Staph Epidermidis or staph aureus. |
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Term
| What's the most common cause of secondary peritonitis? |
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Definition
| Some type of perforation of the GI tract |
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Term
| In secondary Peritonitis, what are the most common pathogens. Give answer in terms of Gram negative, gram + and anaerobic. |
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Definition
Gram negative: E coli
Gram positive: Streptococcus or enterococcus
Anaerobes: bacteroides, specifically B fragilis |
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Term
| What's the general trend for microorganisms in the GI tract? |
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Definition
| The deeper you go, the more gram negative they are and the more likely you will find anaerobes. |
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Term
| What are the flora of the female genital tract? |
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Definition
Lactobacilli
Eubacteria
Clostridia
Anaerobic strep
aerobic strep
Staph Epi |
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Term
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Definition
| It's a hard shell found in abscesses that makes them harder to treat |
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Term
| What types of blood cultures would make you suspect secondary peritonitis? |
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Definition
Anytime bacteroides gets into the blood
OR
anytime you have two enteric bacteria in the blood |
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Term
| What is tertiary peritonitis? |
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Definition
| It's an infection that comes back 48 hours after what was thought to be adequate treatment of secondary. |
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Term
| How do you treat primary peritonitis caused by Cirrhosis? |
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Definition
The most likely agent is E coli.
Treat with Cefotaxime
MAYBE
add clinda or metronidazole if you suspect anaerobes, too |
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Term
| How do you treat primary peritonitis caused by peritoneal dialysis? |
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Definition
Vanc + 3rd gen ceph
OR
AG + 3rd gen ceph
Vanc is for G+, 3rd gen ceph for G- |
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Term
| How do you treat mild to moderate community acquired secondary peritonitis? (6+6) |
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Definition
Ticarcillin-clavulante
Cefoxitin
Ertapenam
Moxiflaxacin
Tigecycline
Metronidazole + one of the following: Cefazolin, cefuoxime, ceftriaxone, cefotaxime, levoflaxacin, or ciprofloxcin |
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Term
| What is the difference between how you treat mild to moderate community acquired Peritonitis vs high severity? |
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Definition
| You cover for enterococcus faecalis in more severe cases because it's more likely to cause severe cases. |
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Term
| how do you treat severe community acquired secondary peritonitis?(5+4) |
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Definition
Imipenem-cilastatin, Meropenam, or doripenam
Piperacillin-tazobactam
Metronidazole + one of the following:
Cefepime, ceftazidime, ciproflaxacin, or levofloxacin |
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Term
| How do you treat health care acquired secondary peritonitis? |
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Definition
Imipenem-cilastatin, Meropenam, or doripenam
Piperacillin-tazobactam
Metronidazole + one of the following:
Cefepime, ceftazidime, ciproflaxacin, or levofloxacin
PLUS
antifungal if you suspect candida
PLUS
MRSA coverage for those colonized with MRSA or significant prior exposure to abx. |
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Term
| How long do you treat primary peritonitis? |
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Definition
Cirrhosis and ascites = 5 days
Peritoneal dialysis = 14 days |
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Term
| how long do you treat secondary peritonitis? |
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Definition
| 4-7 days unless you need to go longer |
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