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Intraperitoneal Abscess in the Right Lower Quadrant
Intraperitoneal Abscess Right Lower Quadrant

Presentation

While most cases of intestinal malrotation present with bilious vomiting in the first month of life[ 1 ], rare cases present in adulthood[ 2 ]. [wjgnet.com]

A high fever is present in the initial stages but in severe peritonitis there may be hypothermia. Tachycardia is usually present. The classic abdominal signs are tenderness on palpation, guarding and rebound tenderness. [patient.info]

Enter the name for this tabbed section: Case Case: A 23yo female presents with acute onset severe lower abdominal pain that woke her from sleep 5 hours prior to presentation. Pain is constant. No nausea or vomiting. No fevers. LMP 2-3 months prior. [emergencyultrasoundteaching.com]

Because abdominal pain, abdominal tenderness, or hepatomegaly is present in only half of cases, many of these patients present with fever of undetermined origin. Leukocytosis is present in most cases. [what-when-how.com]

Note that the residual inflammatory changes ( stage R ) may remain present for a long time after the evacuation, so the patient can be completely symptomfree when there are still considerable US visible abnormalities present. [radiologyassistant.nl]

Entire Body System

  • Fever

    Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 1990; 161:381—396. ‏ معلومات المراجع [books.google.com]

    Supplementary points : Fever : Dazhui ( Du 14 ), Hegu ( Li4 ). Vomiting : Neiguan ( P 6 ), Zhongwan ( Ren 12 ). Explanation : Lanwei ( Extra ) is an empirical point in treating the intestinal abscess. [geocities.ws]

    Aspects Fever and Abdominal Pain [antimicrobe.org]

    Fever and chills and left upper quadrant pain are common. [what-when-how.com]

  • Chills

    Soon the pain becomes continuous and localized in the right lower abdomen near Tianshu ( S 25 ), accompanied by tenderness, mild contracture of the abdominal wall, difficulty in extension of the right leg, fever, chills, nausea, vomiting, constipation [geocities.ws]

    Fever and chills and left upper quadrant pain are common. [what-when-how.com]

    You may have: Swollen belly Diarrhea Fever or chills Lack of appetite and possible weight loss Nausea or vomiting Weakness Cough Your symptoms can be a sign of many different problems. [medlineplus.gov]

    These may be later followed by shock, toxemia, restlessness and irritability, a higher temperature, an increase in the pulse rate, and chills and convulsions. [anaerobicinfections.blogspot.com]

    If toxic appearing female patient with high fever, chills and mucopurlent vaginal discharge suspect – PID. [clinicaladvisor.com]

  • Malaise

    Symptoms are malaise, fever, and abdominal pain. Diagnosis is by CT. Treatment is with drainage, either surgical or percutaneous. Antibiotics are ancillary. [merckmanuals.com]

    CT of abdominal abscess Liver abscesses generally presents with fever accompanied by chills, malaise, sweats and aching pain and tenderness over the liver or epigastrium. [anaerobicinfections.blogspot.com]

    Symptoms Most symptoms are nonspecific and may include: easy bruising fatigue malaise weight loss Other symptoms or diseases may occur as a result of the primary disorder that caused the cirrhosis. [my.ilstu.edu]

  • Rigor

    Intermittent bacteremia can result in recurrent fevers and rigors. Liver seeding can occur through the hepatic portal veins. [sharinginhealth.ca]

    If it is consistently less, it is likely that some unnecessary operations are being performed, and a more rigorous preoperative differential diagnosis is in order. [intranet.tdmu.edu.ua]

    In addition to cutaneous lesions, patients can experience fevers, sweats, rigors, right upper quadrant pain, or pain from bony lytic lesions. [hivinsite.ucsf.edu]

Gastrointestinal

  • Abdominal Pain

    Aspects Fever and Abdominal Pain [antimicrobe.org]

    pain, unspecified R1011Right upper quadrant pain R1012Left upper quadrant pain R1013Epigastric pain R102Pelvic and perineal pain R1030Lower abdominal pain, unspecified R1031Right lower quadrant pain R1032Left lower quadrant pain R1033Periumbilical pain [cms.gov]

    Abdominal pain in general is perhaps one of the most difficult symptoms to evaluate. [clinicaladvisor.com]

    With acute upper abdominal pain, CXR and EKG Management Although the management of abdominal pain is specific to the causative pathology, the following general measures may be useful in the management of acute abdominal pain. [my.ilstu.edu]

    Abdominal distention B. Abdominal pain and rigidity C. Hyperactive bowel sounds D. Right upper quadrant pain B. Abdominal pain causing rigidity of the abdominal muscles is characteristic of peritonitis. [quizlet.com]

  • Abdominal Tenderness

    tenderness R10824Left lower quadrant rebound abdominal tenderness R10825Periumbilic rebound abdominal tenderness R10826Epigastric rebound abdominal tenderness R10827Generalized rebound abdominal tenderness R10829Rebound abdominal tenderness, unspecified [cms.gov]

    Lower abdominal discomfort associated with mucopurulent vaginal discharge. Lower abdominal tenderness on exam or on pelvic exam evidence of cervical motion tenderness, or adnexal tenderness. Fever, leukocytosis, elevated ESR and CRP. III. [clinicaladvisor.com]

    Spiking fever, abdominal pain and tenderness (most often at the lower costal margin), and weight loss are common manifestations. [what-when-how.com]

    tenderness ** (n) コーパス 腹部アンギナ K551 ** ふくぶあんぎな PubMed, Scholar, Google, WikiPedia abdominal angina * (n) 腹部エコー *** ふくぶえこー PubMed, Scholar, Google, WikiPedia 【類義語】 腹部エコー検査, 腹部超音波, 腹部超音波検査 abdominal ultrasound ** (n) コーパス 腹部エコー検査 *** ふくぶえこーけんさ PubMed, Scholar [lsd-project.jp]

    Can easily confuse with PID Objective · Physical exam reveals abdominal tenderness, RLQ tenderness, abnormal bowel sounds, +/- rebound · Patient usually wants to hold still, not to move around · Psoas sign/Obturator sign Assessment/Not to be missed · [my.ilstu.edu]

  • Chronic Abdominal Pain

    Chronicity is a key determinant of the pace of assessment. Prompt evaluation and appropriate treatment of acute abdominal pain are crucial. Chronic abdominal pain usually may be evaluated in a more unhurried manner. [my.ilstu.edu]

Skin

  • Night Sweats

    Heart yin vacuity pattern Main symptoms: Heart palpitations which are worse at night, fearful throbbing, heart and chest pain with a burning hot sensation, restlessness sometimes, insomnia, night sweats, heat in the heart of the palms of the hands and [books.google.com]

Urogenital

  • Pelvic Pain

    CASE #30….23yo F with pelvic pain. Enter the name for this tabbed section: Case Case: A 23yo female presents with acute onset severe lower abdominal pain that woke her from sleep 5 hours prior to presentation. Pain is constant. [emergencyultrasoundteaching.com]

    […] adhesions). · Study published in 2004 describes symptom pattern suggestive of ovarian cancer: pelvic pain, abdominal pain, difficulty eating, bloating, increased abdominal size, and urinary urgency. [my.ilstu.edu]

    A retrocecal appendix may cause principally flank or back pain; a pelvic appendix, principally suprapubic pain; and a retroileal appendix, testicular pain, presumably from irritation of the spermatic artery and ureter. [intranet.tdmu.edu.ua]

Workup

(See Workup, Computed Tomography.) Sequential, multiple organ failure is the main cause of death. [emedicine.medscape.com]

Others are more often subacute in nature (viral hepatitis) and workup can proceed along at a less critical pace. [antimicrobe.org]

[…] the time to the indicated intervention (surgery), thus reducing pain and improving clinical outcomes (e.g., reducing bowel perforation and associated infectious complications). 39 Conversely, time-consuming or unnecessary imaging (or other diagnostic workup [effectivehealthcare.ahrq.gov]

Previous laboratory workup was unremarkable. Abdominal US positive for cholelithiasis without cholecystitis; abdominal CT otherwise negative for acute process. On exam, she was noted to have diffuse abdominal tenderness and a positive Murphy’s sign. [emergencyultrasoundteaching.com]

The role of microbiologic workup of infected fluid has been debated in the last years. Since the causative pathogens can easily be predicted in community acquired infections, bacteriological diagnosis is not necessary. [wjes.biomedcentral.com]

X-Ray

  • X-Ray Abnormal

    Abscesses near the diaphragm may result in chest x-ray abnormalities such as ipsilateral pleural effusion, elevated or immobile hemidiaphragm, lower lobe infiltrates, and atelectasis. CBC and blood cultures should be done. [merckmanuals.com]

Serum

  • Neutrophilia

    Appendicitis Score has also been developed and validated for use in children. 24 It is based on 9 items (migration of pain, anorexia, nausea/vomiting, fever, cough/percussion tenderness, hopping tenderness, RLQ tenderness, leukocytosis, polymorphonuclear neutrophilia [effectivehealthcare.ahrq.gov]

Treatment

In addition, the text addresses the complex interface exists between the medical and surgical management of IBD with important information on medical treatment, endoscopic evaluation, pathology, radiology, and etiology. [books.google.com]

Your outcome will depend on the cause of your infection and how quickly you sought treatment. The right early treatment can significantly improve the outcome for people who develop intra-abdominal abscesses. [hopkinsmedicine.org]

Treatment The recurring themes of treatment in peritonitis are: a) resuscitation, b) antibiotics, c) peritoneal lavage, and d) source control 4.2.1. [ptolemy.ca]

Once-daily ertapenem is an interesting option for the treatment of these infections. [wjes.biomedcentral.com]

Treatment is percutaneous or surgical drainage; antibiotics are necessary but alone are not adequate treatment. [merckmanuals.com]

Prognosis

Prognosis Abscess The prognosis has improved considerably with the advent of drainage under CT scanning. Deaths are generally due to the underlying disease process or unsuspected foci of infection. [patient.info]

Prognosis The introduction of computed tomography (CT) scanning for the diagnosis and drainage of intra-abdominal abscesses has led to a dramatic reduction in mortality rates. (See Computed Tomography.) [medsurgeindia.com]

Prognosis Intra-abdominal abscesses have a mortality rate of 10 to 40%. Outcome depends mainly on the patient’s primary illness or injury and general medical condition rather than on the specific nature and location of the abscess. [merckmanuals.com]

Prognosis The introduction of computed tomography (CT) for the diagnosis and drainage of intra-abdominal abscesses has led to a dramatic reduction in mortality. (See Workup, Computed Tomography.) [emedicine.medscape.com]

Conclusions Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with a poor prognosis. [wjes.biomedcentral.com]

Etiology

In addition, the text addresses the complex interface exists between the medical and surgical management of IBD with important information on medical treatment, endoscopic evaluation, pathology, radiology, and etiology. [books.google.com]

Etiology Intra-abdominal abscesses are classified as intraperitoneal, retroperitoneal, or visceral (see table Intra-Abdominal Abscesses ). Many intra-abdominal abscesses develop after perforation of a hollow viscus or colonic cancer. [merckmanuals.com]

Most common etiologies include: Appendix – acute appendicitis. Ileocecal junction – terminal ileitis (infectious, Crohn’s disease), irritable bowel syndrome. Cecum – cecal volvulus and intestinal obstruction, cecal perforation. [clinicaladvisor.com]

An understanding of the physiology of pain and basic anatomy is essential in the evaluation of abdominal pain, but determination of an etiology can be difficult owing to overlapping symptoms in pathologic processes and to the variable response of individuals [my.ilstu.edu]

Epidemiology

Bowen JC, Brenner HL, Ferrante WA, Maule WF (1992) Gallstone disease pathophysiology, epidemiology, natural history and, treatment options. Med Clin North Am 76: 1143–1157 Google Scholar 2. [link.springer.com]

Epidemiology Incidence The specific incidence of subphrenic abscess is not well known; occurs after 1–2% of abdominal surgeries Most subphrenic abscesses are right-sided. [unboundmedicine.com]

Epidemiology The incidence depends on the cause. In a hospital setting the prevalence of SBP is around 10%. [ 3 ] Three studies of patients with perforated appendicitis found an incidence of postoperative abscess formation of 20%. [patient.info]

Epidemiology and pathophysiology of intraabdominal infections (IAI). [Review] [26 refs]. Infection 26(5):329-34, 1998;-Oct. (15) Laroche M, Harding G. Primary and secondary peritonitis: an update. [Review] [79 refs]. [ptolemy.ca]

Visceral abscesses Liver Abscesses Epidemiology and etiology Pyogenic liver abscesses occur in several settings, including biliary tract infection, direct extension from a contiguous site of infection, portal bacteremia from intra-abdominal septic foci [what-when-how.com]

Pathophysiology

Associated pathophysiologic effects may become life threatening or lead to extended periods of morbidity with prolonged hospitalization. [medsurgeindia.com]

Bowen JC, Brenner HL, Ferrante WA, Maule WF (1992) Gallstone disease pathophysiology, epidemiology, natural history and, treatment options. Med Clin North Am 76: 1143–1157 Google Scholar 2. [link.springer.com]

Risk of subphrenic abscess increases to 10–30% if: Preoperative perforation of a hollow viscus Significant fecal contamination of the peritoneal cavity Bowel ischemia Immunosuppression Delayed diagnosis and treatment of peritonitis Etiology and Pathophysiology [unboundmedicine.com]

[…] cholecystitis mesenteric ischemia and infarction post-operative complications penetrating trauma Causative organisms can include: enterobaceteriacae anaerobes streptococci E coli Bacteroides fragilis Staph and Strep following trauma/surgery return to top Pathophysiology [sharinginhealth.ca]

Prevention

Semi-fowlers aids in drainage and prevents spread of infection throughout the abodominal cavity. [quizlet.com]

Hepatic Problems Cirrhosis and Chronic Liver Failure Best treatment is prevention, with emphasis on: - reducing alcohol consumption - limiting occupational hepatotoxin exposure, and - preventing parenteral transmission of hepatitis B and C. [my.ilstu.edu]

They develop as the body’s immune system attempts to treat the infection and prevent it from spreading. [myvmc.com]

Peritonitis and intraabdominal abscesses Infectious Diseases The Clinician's Guide to Diagnosis, Treatment, and Prevention. 2003; : 144-53 2. Spellerberg B, Brandt C. Streptococcus Manual of clinical microbiology. 2011; : 331-49 3. [jjmicrobiol.com]

Treatment and Prevention The choice of antibiotics depends on the organisms isolated from cultures of blood or abscess material. [what-when-how.com]

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