Abdominal infections

INTRAABDOMINAL INFECTIONS -INTRAPERITONEAL ABSCESSES 

Untreated peritonitis can form abscesses as an extension of the infection process and as an attempt by the host's defenses to contain the infection.Most of the abscesses can originate from colonic sources.Abscesses can occur anywhere in the abdomen and retroperitoneum. They mainly follow the operations, injuries or conditions involving abdominal infection and inflammation, especially when there is a perforation or peritonitis. Symptoms include malaise, fever and abdominal pain. The CT diagnosis. The treatment is drainage, either surgical or percutaneous. Antibiotics are auxiliary.

 

CAUSES 

 

Intra-abdominal abscesses can be  classified as

1. INTRAPERITONEAL 
2. RETRO-PERITONEAL OR VISCERAL 

INTRAABDOMINAL ABSCESSES. Many intra-abdominal abscess developing after perforation of a hollow organ or cancer of the colon. Others develop from the spread of infection or inflammation caused by conditions such as appendicitis, diverticulitis, Crohn's disease, pancreatitis, pelvic inflammatory disease or condition that causes generalized peritonitis. abdominal surgery, particularly those affecting the gastrointestinal tract or bile is another important risk factor: The peritoneum can become contaminated during or after surgery to events such as anastomotic leakage. lacerations and bruises abdominal injuries, especially liver, pancreas, spleen and intestine, abscesses can develop, whether treated or not functioning properly.

Transmitted  infecting organisms generally reflect the normal intestinal flora and a complex mixture of aerobic and anaerobic bacteria. The most common strains of aerobic gram-negative bacilli (e.g. Escherichia coli and Klebsiella) and anaerobic (Bacteroides fragilis in particular). undrained abscess can spread to adjacent structures, damage to the vessels surrounding the passage (due to bleeding or thrombosis), will rupture the peritoneum, or bowel or a skin fistula. sub-diaphragmatic abscess may extend to the thoracic cavity, resulting in empyema, lung abscess or pneumonia. abdominal abscess may track down the thigh or perirectal Fossa. splenic abscess is a rare cause of persistent bacterial endocarditis that persists despite appropriate antimicrobial therapy. 

 

CLINICAL PRESENTATION 

Wide range of presenting complaints , the patients may have general malaise and anorexia or weight loss, other people present in critically ill septic shock with acute abdomen. visceral abscesses do not develop gastrointestinal perforation after local disease (diverticulitis, etc), trauma or surgery, secondary peritonitis subsequently becomes walled by adhesions, inflammatory bowel loops or mesentery omentum abscess and other intra-abdominal abdominal viscera also can develop after primary peritonitis (spontaneous bacterial peritonitis). Sx: fever, pain, nausea, vomiting, anorexia. Physical examination: local pain, perhaps a palpable mass, post-operative evaluation of abscess confused by painkillers and pain in the incision, with more than half is within 10 days of the initial operation. Laboratry: elevated white blood cell count, the yield of direct aspiration of Gram-positive, anti-culture, positive blood cultures ~ 25% depending on the site.

DIAGNOSTIC INVESTIGATIONS 

 

CT SCAN  is more useful. Ultra Sound and Nuclear Magnetic Resonance  (MRI )from time to time ,is not used to guide the drainage. CT or ultrsound guided percutaneous or surgical drainage  to be considered in all cases to confirm the diagnosis, microbiological evaluation, and therapy. Indium gallium is rarely necessary for diagnosis with the advent of these new imaging modalities.

 

TREATMENT 

 

MEDICAL TREATMENT 

 

Antibiotic therapy requires parenteral administration of empirical antibiotics. Start treatment before the abscess drainage, and be careful when all signs of systemic sepsis is resolved. As the abscess fluid generally includes both aerobic and anaerobic organisms early empirical therapy directed against both microbes. This can be achieved by antibiotic treatment or combination therapy with broad spectrum, a management representative. Special treatment, then guided by the results of cultures, retrieved from a boil. Patients who are immunosuppressed, yeast fungi species can be an important pathogenic role, and amphotericin B therapy may be indicated.

 

DRAINAGE 

 

The drainage of pus is mandatory and is the first line of defense against infections gradually. Percutaneous catheter drainage guided by CT became the standard treatment for most intra-abdominal abscesses. It can be difficult to avoid laparotomy, requires anesthesia, eliminates the possibility of wound complications of open surgery, and may reduce the length of hospitalization. It also avoids the possibility of contamination of other areas in the peritoneal cavity. CT-guided drainage of the abscess cavity delimited and can provide secure access for percutaneous drainage. When performed by experienced hands, but also avoids the risk of injury to adjacent organs or blood vessels. 

 

After surgical drainage, clinical improvement should occur in 48-72 hours. The lack of improvement in this period, the second term of the CT review additional abscesses. surgical drainage should be compulsory, if the remaining liquid can be removed with irrigation catheter manipulation, merger or other investments.

 

SURGICAL INTERVENTION 

 

The surgical procedure can also be intended to persist with the content of abscesses, such as hematoma, infection, fungal infection or pancreatic abscesses. Surgical drainage is an option if the skin is dry or fails if the collections are not susceptible to drainage catheter. surgical approach can be either open or laparoscopic drainage (laparotomy) drainage. transperitoneal approach is safer to open a prudent use of preoperative antibiotics. Although contamination of otherwise non-infected sites is an important concern, this complication is particularly reduced if the organizations involved are sensitive to selected drugs. transabdominal examination of the abdomen and allows for full cleaning of fibrin. It also allows full bowel movement to identify and remove all synchronized with the abscesses, which occur in more than 23% of patients.

 

Improved clinical outcomes in three days after treatment indicates drainage. The lack of improvement may indicate inadequate drainage or any other source of infection. If left untreated, inevitably sepsis multiorgan failure. The transabdominal approach open to intra-abdominal abscess can be extremely difficult. Even Matt bowel and adhesions, and loss of anatomic integrity can pose serious problems. This is particularly true when the sensitive organs, like a loop of small intestine, observed intermittent wall abscess or cavity. Therefore, whenever possible, CT-guided drainage is a useful first step.

 

Rheumatic fever symptoms - Leptospirosis -Listeria symptoms

SYSTEMIC / MULTISYSTEM INFECTIONS 

RHEUMATIC FEVER 

Rheumatic fever is an inflammatory disease that can develop after an infection with Streptococcus bacteria (such as strep throat and scarlet fever) and can involve the heart (especially the valves), joints, skin and brain. Rare in developed countries like Great Britain, USA and Australia. Incidence has dropped by 10% of children in 1920 to 0.01% of all children today. This reduction in the incidence reflect advances in infection control and treatment of streptococcal infections to antimicrobials. The disease is still prevalent in developing countries such as the Middle and Far East and Latin America.

Rheumatic fever is preceded by a throat infection with Streptococcus organsisms. After infection with group A streptococcal pharyngeal, usually in childhood (5-15And) is followed by a systemic syndrome I think it is caused by an autoimmune reaction triggered by an infection. Syndrome includes: 1) Arthritis (multiple join pain and swelling) 2), carditis (heart inflammation) 3) The cutaneous manifestations 4) manifestations5 nervous system), fever, joint pain 50% etc.About Patients who develop carditis during the initial phase of the disease will continue to develop long-term heart disease and rheumatic valvular disease.

1) Blood tests: ESF and CRP (non-specific inflammation), leukocytosis2) Studies in X-ray may be a sign of heart infection, pericarditis, pericardial effusion effusion.3) ECG may signs of inflammation of the heart (extended range PR) or, and pericarditis (saddle-shaped ST elevation). Parts of the acute clinical syndrome may recur after the first period. However, projected common disease, skin disease and nerve disease associated with rheumatic fever is excellent with no known long-term consequences. rheumatic heart disease has traditionally been hailed as an important causal factor of cardiac valvular disease and makes the associated morbidity and mortality.

LEPTOSPIROSIS 

Leptospirosis is a rare infection, serious and contagious caused by bacteria of several species of the genus Leptospira, a micro-organism spiral (spirochete). Leptospirosis is often called the swineherd's disease, swamp fever, or mud fever. The organism enters the body when mucous membranes or abraded skin comes into contact with contaminated environmental sources. The infection causes a systemic disease that can often lead to renal and hepatic failure as possible. 

 Leptospirosis is a zoonosis (animal care) infection with a worldwide distribution and incidence. The incidence varies from sporadic in temperate zones endemic in some tropical countries. The disease has a seasonal incidence. Most cases occur during the rainy season in the tropics and in western countries in late summer or early fall, when soil is moist and alkaline. Leptospirosis is usually associated with tropical countries and heavy rains, but most cases occur in temperate climates, probably due to underreporting in some countries.

In general, the prognosis associated with this disease is good, usually with full recovery after infection. more serious systemic infections (Weil's disease), can lead to renal (kidney) or hepatic (liver), myocarditis (heart inflammation), and can be potentially fatal.

Approximately 15-40% of patients are exposed, but do not become ill show serologic (blood or urine or saliva) evidence of a past existing infection. This statistic includes 15% of abattoir workers, home workers, and the incubation period is usually between 7-12 days veterinarians.The, with a range of 2-20 days. About 90% of patients experience a mild form of the disease,
and about 5-10% have the severe form with jaundice, also known as Weil's disease. The natural course of leptospirosis is divided into two very distinct phases, sepsis and immune systems. For a brief period of 1-3 days between the first and second phase, the patient shows some improvement.

LISTERIOSIS 

Listeriosis is an infectious disease caused by foodborne bacteria Listeria monocytogenes. The symptoms are the symptoms of upper respiratory tract and septiceamia. Listeriosis is of particular concern during pregnancy because it can cause miscarriage, stillbirth, premature delivery and sepsis (full body infection) and pneumonia in newborns.

It is an environmental organization that is ubiquitous in soil and rotting matter.It affect both animals and humans, the most common way of infection to humans in contaminated food. The organism can grow at temerature as low as 4 degrees Celsius, and the foods most frequently implicated are soft cheeses, unpasteurized, raw vegetables and the chicken heads. Listeriosis is a rare but serious infection that mostly affects infants, pregnant women, elderly and immunocompromised, L. monocytogenes has also been recently recognized as a cause of self-limiting gastroenteritis, foodborne healthy adults, but the incidence of this phenomenon is unknown....... read more