Subphrenic Abscess Disease

DESCRIPTION

Any localized collection of pus below the diaphragm and in contact with the diaphragm

System(s) affected: Gastrointestinal, Pulmonary
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: N/A
Predominant sex: N/A

SIGNS AND SYMPTOMS

High spiking fever with chills and sweating
Abdominal tenderness
Ileus
Anterior abdominal wall erythema
Abdominal pain
Tachycardia
Chest pain
Nausea
Dyspnea
Localized tenderness on palpation
Pleural effusion
Elevation of diaphragm
Shoulder pain
Hiccups
Tenderness when compressing lower ribs
Rales at lung base

CAUSES

Complications of abdominal surgery cause 50%
Penetrating trauma
Gastrointestinal perforations - appendicitis, diverticulitis
Organisms: Escherichia, Streptococcus, Proteus, Klebsiella, Bacteroides fragilis, cocci, Clostridium

RISK FACTORS

Operative procedure with significant contamination
Patients with chronic disease - cirrhosis, renal failure, malnutrition
Patients on corticosteroids, chemotherapy, radiotherapy
Myelosuppression

LABORATORY

White blood count
Blood cultures
Automated chemical profile

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

CT scan
Ultrasound
Plain films of chest and abdomen display elevation and immobility of right diaphragm, fluid in right costophrenic sulcus; air-fluid level in subphrenic space
Gallium scan

DIAGNOSTIC PROCEDURES

CT or ultrasound directed aspiration

APPROPRIATE HEALTH CARE

Inpatient

GENERAL MEASURES

Antibiotics
Supportive care - nutrition, monitoring, oxygenation, hydration
Swan-Ganz catheter if unstable
Mechanical ventilation if necessary
Vasopressors if indicated

SURGICAL MEASURES

Adequate drainage of abscess - percutaneous and/or surgical
Percutaneous drainage not advised if (1) abscess is multiloculated, (2) drainage route would traverse bowel, uncontaminated peritoneal or pleural space, (3) source of continued contamination still present, (4) fungal infection, (5) pus too viscous
Surgical drainage mandated if patient fails to respond to percutaneous drainage in 24 to 48 hours

ACTIVITY

As tolerated

DIET

NPO until intestinal function returns

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Mortality - 10 to 90% if not adequately drained
Multi-system organ failure
Recurrent abscess
Hemorrhage
Bowel obstruction
Wound dehiscence
Continuing sepsis
Pneumonia
Pleural effusion
Suppurative pylephlebitis

EXPECTED COURSE AND PROGNOSIS

Death if abscess is not adequately drained or patient vigorously supported

ASSOCIATED CONDITIONS

Multi-system organ failure
Systemic sepsis
Fistula

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Worse prognosis
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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