Abdominal abscesses

INTRAABDOMINAL INFECTIONS - VISCERAL ABSCESSES 

INTRODUCTION OF ABSCESS 

An abscess is a local collection of pus is contained in a cavity. Pus is a mixture of dead and dying inflammatory cells called neutrophils, combined with special fluids proteins secreted by cells trying to kill microbes. Abscess containing dead tissue in the center and is surrounded by a fibrous capsule or case. This cap ensures that the infection can spread to other parts of the body. It may be difficult to treat abscess, because antibiotics also have trouble crossing the layer of fibers. Abscesses can occur anywhere in the body, but only those that occur in the abdomen are discussed in this article. These often contain a mix of bacteria which means they can be more difficult to treat.

The most usual organism involved is the Bacteroides fragilis bacteria, which constitutes a small percentage of the normal intestinal flora. intra-abdominal abscesses often develop secondary to peritonitis, an infection of the serous membrane lining the abdominal organs and the walls.

VISCERAL ABSCESS 

Abscesses can also be found on the surface or inside of the digestive organs. Liver abscesses are the most common and about half of all visceral abscesses. These can cause pain in the right upper abdomen. pancreatic abscesses occur late complication of acute pancreatitis. Pancreatitis causes severe abdominal pain radiating center back. Early recognition and treatment of the disorder to prevent abscess formation. And spleen abscesses are rare but can occur if the body is damaged or if the infection in the blood. Patients with immune disorders or sickle cell disease are at higher risk function. Abscesses or near the kidneys are rare, but can lead to the spread of infections of the urinary tract by tract. CT image below shows a large abscess in the liver.

LIVER ABSCESS

Liver abscesses due to bacteria, parasites and fungi organisms. In developed countries, pyogenic abscesses are more common, but amoebas the most common cause worldwide. Usually polymicrobial. Organisms usually of intestinal origin of E. coli and Klebsiella pneumoniae, Bacteroides spp. Anaerobic streptococci and enterococci the most common. Staphylococci and streptococci are more likely if the endocarditis secondary / tooth infection. Fungal (Candida spp. The most common) or opportunistic organisms more likely if the patient's immune response.

Pyogenic liver abscess is secondary iatrogenic liver biopsy or a blocked bile stent. Bacterial endocarditis and dental infections and other causes. No cause in 15%. More common if immunocompromised. 15% of adults with liver abscesses are afflicted with diabetes. Cirrhosis is a strong risk factor. Liver abscess is a complication of umbilical vein catheterization in infants. In children and adolescents are usually compromised immune or trauma. Amebic liver abscess. Transmission is by faecal-oral route. Amoeba invade the intestinal mucosa and can access the portal venous system. E. histolytica causes amoebic colitis and dysentery, but an abscess of the liver is the most common manifestation of extraintestinal infection. Liver abscess may be present without a history of colitis. It may also present for months or years after travel in an endemic area. Affects the right lobe in 80% 0.7

PSOAS ABSCESS 

Psoas abscesses can originate from hematogenous seeding or from contiguous spread from an intraabdominal or pelvic or some nearby structures sources foe example S.aureus is more common in hematogenous or from bony route .its a mixed enteric flora just like abdominal source .Patients have complain of reffered pain to the hip or knee ,with fever ,lower abdominal or back pain.

psoas muscle is the large muscle that runs along the spine, which exceeds the pelvis . It helps to bend the hip so the doctor can do tests, if the hip flexion is painful to make this diagnosis. The clinical symptoms of back pain or pain during bending, the hip may help doctors make a diagnosis as soon trigger them to do imaging like CT (explained below) or MK. psoas muscle abscesses occur when the spread of infection in blood or local authorities, abdomen or pelvis. In addition, infections in bones, spinal column (osteomyelitis) can cause psoas abscesses.

SPLENIC ABSCESS 

Splenic abscesses usually develop by hematogenous spread of infection (eg due to endocarditis). Abdominal pain or spleen occurs more or less 50% of cases and pain in the upper left quadrant plus or minus 25%. Fever and leukocytosis are common. CXR may show infiltrates or left pleural abscess effusions.Splenic most often causaed by atreptococci, S. aureus is the most common cause. Gram negative bacteria can cause splenic abscesses in patients with urinary tract homes, and Salmonella may be responsible in patients with sickle cell anemia. The diagnosis is often only after the death of the patient, the disease is often fatal if not untreted. Most patients undergo splenomegaly and receive additional antibiotics, but percutaneous drainage has been a success.

PERINEPHRIC AND RENAL ABSCESSES 

Over 75% of these abscesses are due to infection and are preceded asceding pyelonephritis.Areas parenchymal abscesses may rupture into the perirenal space. The most important risk factors is the presence of kidney stones that produce a local obstruction of urine flow. Other risk factors include structural abnormalities of the urinary tract, a history of urologic surgery, trauma or diabetes. E. coli. Proteus spp (associated with struvite stones), and Klebsiella spp are the most common etiologic agents.

There is some nonspecific clinical signs  include flank pain, abdominal pain and fever.If patients with pyelonephritis  diagnosis should be consider ,have persistent fever after 4 or 5 days of treatment, urine culture gives a polymicrobial flora in patients with kidney disease known stone, or fever and pyuria occur in conjunction with a urine culture sterile. Treatment includes drainage and administration of antibiotics active against the organisms recovered. Percutaneous drainage is usually successful.