Subphrenic Abscess Flashcards
What is the most common cause of subphrenic abscess?
Postoperative complication of abdominal surgeries, especially appendectomy, cholecystectomy, and perforated peptic ulcer repair.
What is the timeline for subphrenic abscess development post-surgery?
Typically develops 14-21 days after abdominal surgery due to bacterial contamination and abscess formation.
What surgical procedures increase the risk of subphrenic abscess?
Appendectomy, cholecystectomy, gastrectomy, biliary surgery, colonic surgery, pancreatic surgery, and surgery for peritonitis.
What are the key symptoms of subphrenic abscess?
Swinging fever, dry cough, right shoulder pain, pleuritic chest pain, and tenderness over the lower ribs (8th-11th ribs).
Which imaging modality is the best for diagnosing subphrenic abscess?
Abdominal ultrasound, which has >90% sensitivity for detecting abscesses in this region.
Which imaging findings may suggest subphrenic abscess on chest x-ray?
Pleural effusion, elevated hemidiaphragm, atelectasis, or basal infiltrates, though they are non-specific.
What are the common pathogens found in subphrenic abscess?
Polymicrobial infections including E. coli, Bacteroides fragilis, Klebsiella pneumoniae, and Enterococcus spp.
What is the primary treatment for a subphrenic abscess?
Percutaneous or surgical drainage combined with broad-spectrum IV antibiotics (e.g., Piperacillin-Tazobactam or Carbapenems).
Why does subphrenic abscess cause referred shoulder pain?
Irritation of the diaphragm (phrenic nerve) leads to referred pain in the right shoulder.
What antibiotic regimen is recommended for subphrenic abscess with suspected multidrug-resistant organisms?
Carbapenems (Meropenem, Imipenem) or Cefepime + Metronidazole for broad-spectrum coverage, including anaerobes and resistant Gram-negative bacteria.
