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Intraabdominal abcess- types and management .pptx
- 2. Location • Subphrenic • Paracolic • Rt iliac fossa • Pelvic
- 3. Symptoms & signs • Very vague • Low grade fever • Tachycardia • Localised tenderness • Palpable mass
- 4. Investigations • Leucocytosis • USG abd • CT scan
- 5. Management • CT guided drainage • Laparotomy
- 6. Subphrenic abscess Intraperitoneal subphrenic spaces 1. Left superior space(left subphrenic) 2. Left inferior space( lesser sac) 3. Rt superior space( rt subphrenic) 4. Rt inferior space ( rt subhepatic )
- 8. • Extraperitoneal Rt & left perinephric abscess Midline extraperitoneal ( bare area of the liver)
- 9. Symptom • Non specific • “pus somewhere,pus nowhere,pus under diaphragm” • Sweating,wasting,anorexia • Shoulder pain • Persistent hiccoup
- 10. Sign • Swinging pyrexia • Tenderness • Rigidity • Palpable swelling
- 11. Evaluation • Leucocytosis • Plain Xray- tented diaphragm • USG • CT scan • Radiolabelled WBC scan
- 13. Differential Diagnosis • Pyelonephritis • Amoebic abscess • Collapse • Pleural empyema
- 14. Treatment • Clinical observation • Percut drainage • Pointing abscess in the parities – drainage • Surgery Anterior subcostal approach Posterior approach • All loculi must be broken down
- 15. Pelvic abcess • Commonest site - Appendicitis - fallopian tube infection - Diffuse peritonitis - Anastomotic leakage
- 16. Symptom & sign • Diarrhoea • Mucus in stools • Tachycardia, • Abd- lower abd tenderness • DRE- anterior bulge,tender
- 17. Investigation • USG abd • CT scan abd
- 18. Treatment • Rectal drainage • Vaginal drainage • Percut drainage tubes
- 19. Ascites
- 20. Ascites • An excess of serous fluid in the peritoneal cavity • Clinically recognizable > 1500ml
- 21. Quantitative scale • 0 - no ascites • 1+ just detectable • 2+ eaily detectable but small volume • 3+ obvious but not tense • 4+ tense ascites
- 22. Mechanism in cirrhosis • Overflow theory • Underfill therory
- 23. Causes of ascites • Transudates( protein<25g/liter) • Low plasma protein Malnutrition Nephrotic syndrome Protein losing enteropathy • High CVP Congestive cardiac failure Constrictive pericarditis • Cirrhosis
- 24. Exudates (protein > 25g/dl) Tuberculosis Peritoneal malignancy Budd chiari synd Pancreatic ascites Chylous ascites Meig’s synd
- 25. Clinical features • Distended abd • Shifting dullness • Fluid thrill • CHF • Cirrhosis
- 26. Evaluation • Aspirate • SAAG ratio • Cytology • USG • CT abd
- 27. Treatment • Sodium restriction • Diuretics • Paracentesis • TIPS • Surgery Leveen shunt • Side to side Portocaval shunt
- 28. Complication • SBP • Tense ascites • Abd wall hernia