Clinical Abd. pain (severe on the inflamed site, increases on movement), anorexia, nausea, vomiting, dehydration due to hypovolemia, chills, fever. Hypotention, tachycardia, oliguria, tachypnea (due to hypovolemia, hypoxia, and acidosis Adynamic ileus
Tenderness, guarding, rebound: helpful for localising the site and the diagnosis. Bowel sounds: initially hyperactive then silence….
Dx Leukocytosis, left-shift (stabs) Hemoconcentration and dehydration: high hematocrit and BUN High ALT/AST, low platelets, acidosis, high D-dimer Plain abdominal X-ray, chest X-ray Abdominal US, CT Surgical or CT-guided sample: gram and culture, BC (20-30% bacteremia)
Prognosis Age Co-morbidity Peritoneal contamination time “Foreign” substance (biliary and pancreatic secretions) Microorganism Mortality: %
Tx Surgery + supportive+ antibiotics (leukocytes, fever, bowel sounds…) 5- 7 days after an appropriate surgical control