This document discusses different types of intra-abdominal abscesses including their locations, symptoms, investigations, and management. It describes subphrenic, pelvic, and perinephric abscesses in more detail. Symptoms of intra-abdominal abscesses are generally vague but may include low grade fever, tachycardia, and localized tenderness. Investigations include blood tests showing leukocytosis as well as imaging like ultrasound, CT scan, and radiolabeled white blood cell scans. Management involves CT-guided or surgical drainage depending on the location and type of abscess. The document also discusses ascites including causes, clinical features, evaluation, treatment, and complications related to ascites.

1. Intra abdominal abcess

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