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.

Gastrointestinal infections

GASTROINTESTINAL INFECTIONS

In medical terminology " gastrointestinal " refers to the stomach. A gastrointestinal infection that is affecting the stomach or intestines and usually lead to diarrhea. Some infections, such as E. coli and shingles is caused by bacteria. Others, such as Norwalk and Sapporo, are caused by viruses. Giardia is a gastrointestinal infection caused by parasites. Many of these infections are very contagious. An abdominal infection can spread if a person with traces of bacteria on their hands to touch another person or food from another person. Salmonella is a bacterial infection that is transmitted in this way. It is often found in eggs and chicken. If these products are not properly handled or undercooked, people can become sick. 

 

Gastrointestinal infections associated with eating undercooked contaminated meat, usually that goats, sheep and cows. The infection in the intestines usually caused by an overgrowth of certain bacteria or yeasts. gastro-intestinal infection usually causes germs diarrhea.Which are responsible for diarrhea depends on the geographical infected person, their level of sanitation, economic development, and hygiene. Gastrointestinal infections are common in bacteria, Salmonella, Shigella, E. coli, and parasites such as Giardia and Cryptosporidium. The most common symptoms are: abdominal cramps followed by diarrhea, fever, loss of appetite, nausea, vomiting, weight loss, dehydration, mucus or blood in the stool.

Shingella is a gastrointestinal infection caused by bacteria. Shingella usually transmitted through consumption of infected material, such as water. The bacteria can cause dysentery, which is a disease in which the intestine is inflated. Mucus lining the intestinal wall usually start to decompose and can become apparent in the gut. A person may also develop bleeding ulcers as a result of this infection.

 

The viruses that cause diarrheal diseases, also known as viral gastroenteritis, can pass through a house (or college dorm or anywhere else where many people live together) quickly because they are highly infectious. Luckily, the diarrhea usually goes away by itself within a few days. For teens and healthy adults, viral gastroenteritis is a common problem, but minor. But young children and people with chronic diseases, can lead to dehydration that requires medical attention. Many types of bacteria and parasites can also cause gastrointestinal infections and diarrhea. Most are not serious and disappear after a few days, but others may be very serious.

The incubation period for a gastrointestinal infection can vary depending on the particular germ at the origin. For example, the Shigella incubation period is usually 2-4 days but the period for viral infections ranges from 4-48 hours. Parasitic generally have longer incubation periods, such as Giardia, where the symptoms can take from one to four weeks appears. Then, as the germ and the general health of the person, a diarrheal illness lasting several days or weeks.

Diarrheal infections are very contagious. They can spread from person to person by dirty hands, contaminated food or water and some animals. Most cases are contagious for as long as someone has diarrhea, but some infections can be contagious for longer.

The most effective way to prevent contagious diarrheal infections is to wash your hands frequently. Dirty hands carry germs into your body when you do things like biting your nails or use your hands when you eat. It is important to always wash hands with soap and water after using the toilet and before eating, especially if you know there's a disease going around. Make sure bathroom surfaces are clean can also help prevent infection.

 

 Make sure kitchen counters and cooking utensils are clean, too, especially after they have been in contact with raw meat, eggs and poultry. Avoid eating foods that have been neglected for a few hours, even if it has been reheated, because toxins can survive in food.

If you're traveling or camping, never drink the streams, springs or lakes where the local health authorities have certified the clean water to drink. In some developing countries, you can stick to bottled water and drinks rather than tap water - and watch street vendors to buy food. Pets, especially reptiles, can spread bacteria if not kept separate from the family of European food sectors. Do not clean pet cages or bowls in the sink itself, and the family to prepare meals. And always wash your hands after handling your pet .

 

Most infections, infections that cause diarrhea infections, especially viral, will disappear without treatment. Relax at home and drink plenty of fluids to avoid dehydration are the best ways to overcome the disease. If you become dehydrated, you may need to go to hospital for intravenous (IV) fluids to replace those lost to diarrhea, vomiting and fever. Most infections caused by gastrointestinal viruses and many bacterial infections without treatment, but someone with a weakened immune system that receives a bacterial disease of the bowel may need to be prescribed antibiotics to prevent infection spread throughout the body.

What is peritonitis ?

INTRAABDOMINAL INFECTIONS 

PRIMARY ( SPONTANEOUS ) BACTERIAL PERITONITIS ( PBP ) 

Spontaneous bacterial peritonitis (SBP) is to develop peritonitis (infection of the abdominal cavity), although there is no obvious source of infection.It occurs almost exclusively in cases of portal hypertension of people (more of Increased portal vein pressure ), usually a result of cirrhosis of the liver and liver.It may also occur in nephrotic syndrome patients.

Primary bacterial peritonitis  is seen as the result of a combination of factors associated with cirrhosis and ascites, and prolonged bacteremia secondary to compromised host defenses, maneuvers intrahepatic blood colonized, and the defective bactericidal activity in the ascites fluid. Contrary to previous theories, transmucosal migration of bacteria in the intestine of ascites is no longer considered to play an important role in the etiology of SBP. With regard to the compromised host defenses, patients with chronic liver disease often have severe acute deficiency of the complement and possibly a system malfunction of neutrophils and the reticuloendothelial system.

ETIOLOGIES 

Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.

SIGN AND SYMPTOMS 

Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic   encephalopathy  could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.

MORTALITY / MORBIDITY 

The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.

DIAGNOSIS 

The diagnosis of  Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from  the cavity of abdomen .  If the fluid contains bacteria or a big amount  of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.

TREATMENT 

Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.

PREVENTION 

Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time. 

SECONDARY PERITONITIS 

Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

CLINICAL FEATURES 

Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .

DIAGNOSIS AND TREATMENT 

Studies marked leukocytosis with a left  shift to find the source of peritonitis are the main treatment.  Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.

PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS 

Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical  therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter  removal scheme should be considered if the patient does not improve within 48 hours ....... read more