Splenic abascess.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Pathophysiology

3. Pathophysiology Alcoholics, diabetics, and patients who are immunosuppressed are among the most susceptible to splenic abscesses. Preexisting splenic tissue injury and bacteremia

4. Pathophysiology Hematogenous embolization to a previously normal spleen . Hematogenous spread in the presence of previously altered splenic architecture . splenic infarcts (from trauma) or multiple splenic infarcts (from sickle cell disease or vasculitis . Contiguous spread -pancreatic abscess, gastric or colonic perforations, or subphrenic abscesses

5. Organisms associated

6. Organisms associated Aerobes – Gram-positive cocci - Streptococcus ,    Staphylococcus,  and  Enterococcus   gram-negative bacilli (  Escherichia coli, Klebsiellapneumoniae , Proteus,   Pseudomonas , and  Salmonella Anaerobes -  Peptostreptococcus , Bacteroides , Fusobacterium ,   Clostridium,  and  Propionibacterium acnes.

7. Organisms associated Polymicrobial (up to 50% of cases) Fungi -  Candida Unusual flora –   Burkholderiapseudomallei Actinomycetes mycobacteria

8. Symptoms

9. Symptoms The classical triad of Fever left-upper-quadrant pain Splenomegaly Kehr sign -shoulder pain Pleuritic chest pain General malaise

10. Signs

11. Signs Abdominal tenderness Muscle guarding in the left upper quadrant. Edema of the soft tissues overlying the spleen. Costovertebral tenderness. Splenomegaly . Chest findings are nonspecific – dullness at the left lung base left basilar rales elevation of the left hemidiaphragm

12. Prognosis

13. Prognosis Bad.

14. Complications

15. Complications Life-threatening hemorrhage from the splenic parenchyma or hilar vessels. Pneumothorax Left-side pleural effusion Subphrenic abscess Perforation of the colon, stomach, or small intestine Pancreatic pseudocyst or fistula Postsplenectomy thrombocytosis OPSI

16. Complications Atelectasis or pneumonia Subphrenic abscess abscesses in the spleen's upper pole can fistulize into the pleura. Abscesses originating from the lower pole can involve the splenic flexure and communicate with the colonic lumen. The stomach and pancreas can be affected

17. Complications Late iatrogenic complications, such as residual intra-abdominal abscesses, pancreatic or enteric collections. Intestinal obstruction and ventral hernia Recurrent splenic abscess

18. Investigations

19. Investigations Laboratory Studies Routine- leukocytosis Special- Recurrent positive blood cultures . Imaging Studies Tissue diagnosis Cytology FNAC Histology

20. Diagnostic Studies

21. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

22. Radiograph

23. Radiograph Plain radiographic films of the abdomen and chest- nonspecific Elevated left hemidiaphragm Pleural effusion . abnormal soft-tissue density or a gas collection in the left upper quadrant

24. Management

25. Management Empiric broad-spectrum antibiotic therapy later tailored to the culture results Surgical splenectomy laparoscopic splenectomy Percutaneous CT-guided drainage open splenotomy and drain the collection.

26. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

27. Get this ppt in mobile

28. Get my ppt collection https:// www.slideshare.net/drpradeeppande/edit_my_uploads https:// www.dropbox.com/sh/x600md3cvj85woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl=0 https://www.facebook.com/doctorpradeeppande/?ref=pages_you_manage