外科感染英语

Surgical Infection,DefinitionClassificationsEtiologyClinical ManifestationManagementSpecific Surgical InfectionsCharacteristics of Hand Infections,Key Points,Infections: Presence of organism in normally sterile site accompanied by an inflammatory host responseInfections be treated by surgical interventionInfections following surgical procedure (wound or distant site),Definition,Non-specific infectionFuruncle & CarbuncleCellulitis & ErysipelasHand infectionAcute appendicitisAcute peritonitisBreast abscess,Classifications：Characteristic,Classifications: Characteristic,Specific infectionTuberculosisFungal infectionTetanusGas gangrene,Acute infection (2M)TuberculosisSub-acute infection (3w-2M)Urine tract infectionFungal infection,Classifications：Course of Disease,Opportunistic InfectionSuperinfectionNosocomial Infection,Classifications：Others,Local phaseSkin infectionSoft-tissue infectionHand infectionAbscess,Systemic phaseBacteremiaSepsis,Classifications：Others,Etiology of surgical infection,Pathogenic microorgansimLocal factorsSystemic factors,BacteriaVirusFungi,EndotoxinEctotoxinEnzyme,Etiology：Pathogenic Microorgansim,TraumaIschemia and HypoxiaObstructionPresence of Foreign Bodies and Necrotic TissuesIonizing RadiationEdema,Etiology：Local Factors,Obstruction,Ischemia,Trauma,Severe TraumaDMCancer, ChemotherapyLeukemiaAIDSImmunodeficiencyMalnutrition,Etiology：Systemic Factors,CureDissemination Abscess formationBacteriamia & Sepsis & SIRS & MODSChronic infection,Results：Non-specific Infections,Mixed infectionTuberculosisSystemic infectionTetanus, gas gangreneOpportunistic infectionFungi,Results：Specific Infections,Clinical Manifestation,Localized surgical infectionRednessSwellingPainHeatLoss of function,FeverChillsTachycardiaLeukocytosis & left shift of WBCs,Clinical Manifestation,Tachycardia,Fever,Fatigue,Synergistic Gangrenecaused by streptococci & staphylococci(self-injection with heroin),Chill, FeverFlushingWarm ExtremitiesMetastatic abscessShock in late phase,Severe Systemic Infection (Gram-positive),Clinical Manifestation,Severe Systemic Infection (Gram-negative),Chill, FeverCold ExtremitiesShock in early phaseOliguriaHigh-output heart failureDisturbed sensorium,Clinical Manifestation,HPIPhysical ExaminationGeneral ConditionRegional Symptoms Mal-function of Related OrgansCharacteristic Manifestations,Diagnosis,Diagnosis：,Lab TestCBC Culture Sensitivity TestOthersCTUltrasonic X-ray,Diagnosis,Intravenous cannula-purulent drainage or thrombophlebitisRectal examination-pelvic abscessAuscultation of chest-pneumonia,Physical Exam,Accumulation of extracellular fluidColor, odor, character Be useful in categorizing the causative organismGram stainan essential procedure for diagnosis and treatment,Physical Exam： Exudate,Breast abscess,Being necessary for diagnosis sometimesEspecially for granulomatous infectionTuberculosisblastomycosis,Physical Exam： Biopsy,Operative exploration & Biopsy,Exudatethe most reliable diagnosis for treatmentBoth aerobic and anaerobic cultureBloodDiagnostic step for unknown sourceFail to capture causative organisms in bacteremiaUnnecessary to diagnose sepsisSputumUrine,Culture,General SupportingTemperature Control Management of Water and Electrolytes BalanceNutrition SupplementHypoalbuminemiaUderlying FactorsVital Signs Monitor,Management,Immobilization of the infection areaEffective local careRelief of swelling & painProper DressingPhysical Therapyto increase local blood supplyto facilitate exudation,Management,Surgical TherapyDebridement of Infected or necrotic tissuesHarboring foreign objects & microorgnismsPoor blood supplyDecreasing host resistanceSkin GraftingParacentesis Drainage of Abscess,Management,Simple appendicitis treated by early operation,Removing foreign body,Neglected, perforated appendicitiswith a complex lower abdominal abscessassociated with necrosis of adjacent tissue,Principle of Antibiotics Management,Acute sever trauma and infectionProphylactic Management,Indications,Bacteriostatic agentsPrevent growth of bacteria Bacteriocidal agentsActually kill bacteria,Management：Antibiotics,Effective agent against the infecting organismAdequate contact between agent and organismAbsence of toxic side effect of the agentAugmentation of host defenses to maximize antibacterial effects,Management：Antibiotics,Culture before antibiotic therapyAdminister antibiotics on empiric basis before the laboratory reportsCulture and sensitivity test (Evidence basis)a combination of antibiotics for probable polymicrobic infection,Management：Antibiotics,Colonization The quantitative appearance of changes in the microflora that are induced by antibiotic therapySuperinfection A new microbial disease introduced or potentiated by antibiotic therapySuperinfection is frequently the result of colonization.,Colonization & Superinfection,for potentially contaminated woundsOnly an adjunct and NOT a substitute to good surgical technique,Antibiotic Prophylaxis,Clean procedureno antibiotics are necessaryClean contaminated procedureContact of the interior of respiratory, urinary,GI tractsContaminated procedureComplicated by gross spillage of intestinal contents or wounds secondary to traumaDirty woundsIn contact with intraabdominal or perirectal abscess,Antibiotic Prophylaxis,MalnourishedObeseElderlyImmunodeficientShock or MOFPoor blood supply to the operative region,Antibiotic Prophylaxis,early and enough for adequate tissue and body fluid levelsBeing necessary to maintain adequate tissue levels intra-operativelylength of operation and serum half-life of antibiotics,Antibiotic Prophylaxis,Antibiotic Prophylaxis,Superficial Infection,StaphylococciG+beta hemolysinsSuppuration and Characteristic pusthick, yellow, without foul smellingS. aureus furuncle & carbuncle S. epidermidis after surgery with foreign material,Staphylococcal Infection,ObesityDiabetesPoor hygiene conditionIntravenous drugs,High Risk Factors,Furuncle: characteristic,FaceButtocksThighsGroinBreastAxil area,Infection involving an entire hair follicle and the underlying skin tissue,38 or T90 bpmRR 20 bpm or PaCO2 12000 or 39.5, change in mental status, hypotension, shockWBC25,000/dl,Mortality & Prognosis of Sepsis,Treatment of Sepsis,Debridement of primary infectionAntibiotics therapy Supportive & Miscellaneous Therapy,Supportive & Miscellaneous Therapy,Recovery of enteral nutrition as possibleCorrection of acid-basis & electrolyte balanceDiureticsNaloxoneCorticosteroidsTransfusion of leukocyte concentrateImmunotherapy,Resulted from exotoxin produced by C.tetania severe disease primarily of older adults who are unvaccinated or inadequately vaccinatedCharacterized by hypertonia, painful muscular contractions, muscle spasms,Tenanus,Clostridium tetani,An obligate anaerobic gram-positive bacillusFormation of spores which are resistant to heat, desiccation, and disinfectantsBeing ubiquitous in soil, house dust, animal intestines, and human feces,Etiology,Animal bitesBurnsChronic otitis Crush injuriesDental proceduresElective surgical abrtionFrostbite woundsHuman bitesPuncture woundsSurgery,Common sources,Median Incubation period = 7 days73% = 4-14 days 15% = 14daysclinical manifestations occurring within 1 week of an injury have more severe clinical coursesMild penetrating wound even be healed before toxin development,Incubation Period,ArrhythmiasComaDifficulty breathingDifficulty swallowingHigh blood pressureIrritabilityNeck pain & stiffnessRestlessnessSeizures,Clinical Manifestation,Trismus (lockjaw)75%Pain & Stiffness (neck, back, abdomen)DysphagiaRestlessnessReflex spasms.“Risus sardonicus” expression,Clinical Manifestation:,Trixmus/lockjaw,Risus sardonicus expression,Neck pain & stiffness,Opisthotonus,Seizures,Coma,Wound ManagementTATTetanus vaccine (DPT)Tetanus immune globulin (for high-risk wounds or person who has never been immunized injections),Prevention,to remove necrotic tissue and foreign bodiesto create an aerobic environment,Surgical therapy,AnticonvulsantsValiumLuminalSkeletal muscle relaxantsBaclofen Dantrolene AntitoxinsTetanus immune globulins,Medications,AntibioticsPenicillin GTetracyclineNeuromuscular blocking agentsVecuronium,Medications,Overallmortality is approximately 45%In the United Statesmortality rate is 6% (previously tetanus toxoid) mortality rate is 15% (unvaccinated individuals),Mortality,Most people recover from tetanus completelyRecovery from 2 to 4 monthsSome individuals have low muscle tone after recovery.,Prognosis,Hand Infection,Anatomy factorsMultiple compartments and planes in handInfections are dictated by fascial boundaries in hand,Background,ParonychiaFelonTenosynovitisDeep fascial space infections,Classifications：Characteristic,The lateral nail foldStarting as a cellulitis, progression to abscess formationEponychia (spreads to the proximal nail edge),Paronychia：Characteristic,Recent trauma to lateral nail foldNail bitingManicuringDishwashing Finger sucking （children）,Paronychia：history,Edema, Erythema, Pain along lateral edge of nail fold May have extension to proximal nail edge (eponychium) Possible abscess formation,Paronychia：Signs & Symptoms,Staphylococcus & Streptococcus in most casesMycobacteria and fungi in chronic cases or immunocompromised patientsAnaerobes in the pediatric population due to finger sucking.,Etiology： Microorganism,If no frank abscess frequent hot soaks & antibiotics If pus is present incision and drainageIf pus has tracked beneath the nail remove an adjacent longitudinal section If eponychia is resulted remove the entire nail plate,Management,Eponychia (Subungual abscess )Osteomyelitis of the distal phalanx Development of a felon Chronic infection,Complications,Most resolve in 2-4 daysChronic infections are likely fungal infections.,Prognosis,The infection of distal palmar phalanx,Felon：Characteristic,Compartmentalized infectionIncreased pressure within the closed compartmentImpaired venous outflowa local compartment syndrome and myonecrosis and osteomyelitis,Felon：Characteristic,Staphylococcus & Streptococcus is the most common causative organismTypically direct inoculation of bacteria by penetrating traumaMay be caused by hematogenous spreadLocal spread from an untreated paronychia,Etiology： Microorganism,Recent trauma to finger pad or paronychiaTypically Throbbing Pain Swelling, Pressure, Erythema,Felon：Signs & Symptoms,Painful, Tense, Erythematous finger pad Pointing of abscess possibly present Signs typically limited to area distal to the distal interphalangeal joint Evidence of penetrating trauma,Felon：Signs & Symptoms,Frank abscess & tense finger pad is the indication A longitudinal incision over the area of greatest fluctuanceTo avoid penetration of the tendon sheath, the incision should not extend to the distal interphalangeal creaseUsing a hemostat, bluntly dissect the wound to promote drainageIrrigating the cavity copiously and loosely pack with a gauze wick.,Incision & Drainage,scarringsensory lossunnecessary paininstability of the finger padspread of infection into the adjacent tendon sheath.,Incision & Drainage,Reevaluate the wound 48 hours after initial incisionIf continued drainage is present, loosely repack the woundIf no further drainage is present, repacking is unnecessaryContinue antibiotics for 5-7 daysThe prognosis is good, with healing in 1-2 weeks,Felon：Follow up,OsteomyelitisNecrosis Sinus tract formation Septic joint Tenosynovitis,Complications,The tenosynovial coverings of the second, third, and fourth digits do not communicate with either the radial or ulnar bursae in most individualsInfection within a tendon sheath usually is the result of direct inoculation of bacteria from penetrating trauma.,Infectious Tenosynovitis,Recent penetrating trauma to handGonococcal infection, particularly disseminated infectionPain, especially with passive extension of fingerEdema of entire fingerVariable history of fe