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Chapter 77. Intraabdominal Infections

Student Questions

Which of the following would be considered a primary intraabdominal infection?

A. A patient with small bowel obstruction and peritonitis after receiving chemotherapy

B. A patient who was knifed in the abdomen with rupture of the intestine

C. Peritonitis in a patient undergoing peritoneal dialysis

D. A patient who presents with a perforated GI ulcer

Answer: A.

Option A: Incorrect. A small bowel obstruction is a cause of secondary peritonitis due to perforation.

Option B: Incorrect. An intraabdominal trauma is a cause of secondary peritonitis due to perforation.

Option C: Correct. Both spontaneous bacterial peritonitis from cirrhosis and peritonitis secondary to CAPD are types of primary peritonitis.

Option D: Incorrect. A perforated GI ulcer is a cause of secondary peritonitis.

In secondary peritonitis, bacteria enter the peritoneum by which of the following mechanisms?

A. Via a peritoneal dialysis catheter

B. Via perforation of the GI tracts

C. Via transmigration through the bowel wall

D. Via transmigration through the bloodstream

Answer: B

Option A: Incorrect. Peritoneal dialysis catheters are a cause of primary peritonitis.

Option B: Correct. Secondary peritonitis is due to a perforation of the GI tract or female genital tract.

Option C: Incorrect. Primary peritonitis (spontaneous bacterial peritonitis) is caused by transmigration of bacteria through the bowel wall.

Option D: Incorrect. Secondary peritonitis is due to a perforation of the GI tract or female genital tract.

Which is most appropriate for the initial treatment of community-acquired, high-severity, complicated intraabdominal infections?

A. Moxifloxacin

B. Cefoxitin

C. Amoxicillin-clavulanate

D. Piperacillin-tazobactam

Answer: D

Option A: Incorrect. Fluoroquinolones are not recommended for the initial treatment of high risk or high severity infections.

Option B: Incorrect. Single agent cephalosporins are only recommended for mild-to-moderate infections.

Option C: Incorrect. Oral antimicrobials are inappropriate for the initial treatment of high risk or high severity infections.

Option D: Correct. Single agent extended-spectrum penicillins with β-lactamase inhibitors are as effective as combinations of aminoglycosides or fluoroquinolones with antianaerobic agents. The intravenous route is also the ...

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