Intra-Abdominal Infection

Intra-abdominal infection is

• infection that contained within abdominal cavity

• main areas of infections are in intraperitoneal or retroperitoneal

• viral infection is the most common cause

• asymptomatic

• hemodynamic stability

The following is the organ affected in each IAI disease

Groups:

(a) Intraperitoneal

,

(b) Retroperitoneal

• ureters

• sigmoid colon

• liver, spleen

• adrenal gland

• stomach

• rectum

• 1st pat duodenum

• jejenum

• kidney

• transverse

• ileum

The following is true regarding peritonitis & abscess

• peritonitis is an acute inflammatory response to microbes, chemical, irradiation, or foreign-body injury

• abscess is a chronic inflammation occurred without preceding peritonitis

• peritonitis is localized while abscess is generalized

• can be located within peritoneal cavity or visceral organ

• formation of intra-abdominal abscess usually takes days to weeks

Answer explanation

Peritonitis is generalized while abscess is localized.

Formation of intra-abdominal abscess usually takes weeks to years.

The following disease is a common type of IAI EXCEPT

• Appendicitis

• Diverticulitis

• Intra-abdominal post-operative infections

• Pelvic inflammatory disease

• Esophagitis

Answer explanation

Esophagus is not part of the abdominal cavity organ, hence not a type of IAI.

Peritonitis can be divided into primary, secondary, and tertiary, based on their etiologies.

Groups:

(a) Primary

,

(b) Secondary

,

(c) Tertiary

• Persistent/ Recurrent infection after adequate initial therapy

• No evident source of bacteria from abdomen

• Evident focal disease process

• Perforation of GIT

• Spontaneous bacterial infection

• No evident source of bacteria from visceral organ

• Most common in clinical practice

• Common in hospitalized alcohol cirrhotic patient

• Uncommon

Cirrhotic Peritonitis is _____

• also known as spontaneous bacterial peritonitis (SBP)

• usually occurs in advanced liver cirrhotic patients with ascites

• due to bacterial translocation from the gut into the bloodstream, then into the ascitic fluid

• a non-severe complication of liver cirrhosis

• categorised as primary peritonitis

Answer explanation

It is a severe complication.

Perforation peritonitis is _____

• presence of hole on abdominal organ

• caused by GIT perforation, e.g. stomach, colon etc

• not caused by appendix and gallbladder rupture

• complicated with abdominal organ cavity content spillage into the peritoneal space

• categorized as tertiary peritonitis

Answer explanation

It may also be caused by gallbladder or appendix rupture.

It is categorized as secondary peritonitis.

The following is true regarding peritoneal dialysis (PD)

• may increase risk of either primary or secondary peritonitis

• blood waste filtration via peritoneal lining in renal failure

• catheters exits, tunnels, and dialysate are common contamination source

• secondary peritonitis occurs infrequently than primary

• primary peritonitis is caused by bacteria from drainage bag of PD

Answer explanation

Primary peritonitis is infrequent than secondary peritonitis.

Bacterial source comes from the bloodstream that translocate into the peritoneum.

Primary and secondary peritonitis vary in clinical presentations.

Groups:

(a) Primary Peritonitis

,

(b) Secondary Peritonitis

• Oliguria

• Not in acute distress

• Abdominal tenderness

• In acute distress

• Tachypnea & tachycardia

• Initially normal, then increase continuously

• Temperature is slightly elevated or not at all in peritoneal dialysis

• Hypoactive bowel sound

• Worsening encephalopathy in cirrhotic patients

• Abdominal guarding/boardlike

• Faint then ceased bowel sound

• Cloudy dialysate fluid in peritoneal dialysis

Laboratory tests in secondary peritonitis may show

• elevated BUN & hematocrit

• early acidosis, then into acidosis and lactic acidemia

• small/large bowel distension

• presence of free air in the abdomen

• mildly elevated WBC

Answer explanation

Early ALKALOSIS, then into acidosis and lactic acidemia.

Mild elevated WBC is seen in primary peritonitis. WBC elevated is significantly higher in secondary peritonitis.