Intraabdominal abcess- types and management .pptx

intrabdominal abcess
location
Subphrenic
Paracolic
Rt iliac fossa
Pelvic

1. Intra abdominal abcess

2. Location Subphrenic Paracolic Rt iliac fossa Pelvic

3. Symptoms & signs Very vague Low grade fever Tachycardia Localised tenderness Palpable mass

4. Investigations Leucocytosis USG abd CT scan

5. Management CT guided drainage Laparotomy

6. Subphrenic abscess Intraperitoneal subphrenic spaces Left superior space(left subphrenic) Left inferior space( lesser sac) Rt superior space( rt subphrenic) Rt inferior space ( rt subhepatic )

7. Extraperitoneal Rt & left perinephric abscess Midline extraperitoneal ( bare area of the liver)

8. Symptom Non specific “pus somewhere,pus nowhere,pus under diaphragm” Sweating,wasting,anorexia Shoulder pain Persistent hiccoup

9. Sign Swinging pyrexia Tenderness Rigidity Palpable swelling

10. Evaluation Leucocytosis Plain Xray- tented diaphragm USG CT scan Radiolabelled WBC scan

11. Differential Diagnosis Pyelonephritis Amoebic abscess Collapse Pleural empyema

12. Treatment Clinical observation Percut drainage Pointing abscess in the parities – drainage Surgery Anterior subcostal approach Posterior approach All loculi must be broken down

13. Pelvic abcess Commonest site Appendicitis fallopian tube infection Diffuse peritonitis Anastomotic leakage

14. Symptom & sign Diarrhoea Mucus in stools Tachycardia, Abd- lower abd tenderness DRE- anterior bulge,tender

15. Investigation USG abd CT scan abd

16. Treatment Rectal drainage Vaginal drainage Percut drainage tubes

17. Ascites

18. Ascites An excess of serous fluid in the peritoneal cavity Clinically recognizable > 1500ml

19. Quantitative scale 0 - no ascites 1+ just detectable 2+ eaily detectable but small volume 3+ obvious but not tense 4+ tense ascites

20. Mechanism in cirrhosis Overflow theory Underfill therory

21. Causes of ascites Transudates( protein<25g/liter) Low plasma protein Malnutrition Nephrotic syndrome Protein losing enteropathy High CVP Congestive cardiac failure Constrictive pericarditis Cirrhosis

22. Exudates (protein > 25g/dl) Tuberculosis Peritoneal malignancy Budd chiari synd Pancreatic ascites Chylous ascites Meig’s synd

23. Clinical features Distended abd Shifting dullness Fluid thrill CHF Cirrhosis

24. Evaluation Aspirate SAAG ratio Cytology USG CT abd

25. Treatment Sodium restriction Diuretics Paracentesis TIPS Surgery Leveen shunt Side to side Portocaval shunt

26. Complication SBP Tense ascites Abd wall hernia