MEDRADSC 3C03 Lecture Notes - Lecture 14: Ulcerative Colitis, Streptokinase, Phlegmon
18 Jun 2018
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Abscess:
Localized area of inflammation containing pus- normally surrounded by neutrophils
onot free flowing fluid– it is localized, neutrophils try to limit the effects of the expansion
ofibroblasts may eventually enter the area to wall off the abscess so the antimicrobial
agents can’t get to the infection
Drain these because antibiotics won’t do anything: no blood supply, the antibiotics will never
get there
Symptoms of acute inflammation systemic:
oMild fever, malaise, fatigue, headache, loss of appetite
oIf infection cause the inflammation: severe fever (will limit the growth of the
microorganism)
Old people don’t have good temp regulation
Locations:
oRetroperitoneal
oPelvis
oOrgan: liver (amebic: infections from microorganisms from things you eat), pancreas,
spleen, renal
oBowel (enteric):
May cause abscess because broken skin lesions (bacteria can get in, bowel
become inflamed/sticky):
Recent surgeries
Crohns (can get abscesses when they stick the two good ends together)
Ulcerative colitis/ Diverticular
oSubphrenic right/left: post surgery
oSubdiaphragmatic: difficult to access (often from pancreatic/gastric/biliary surgery)
Increased risk due to surrounding pleura
Modality:
oUS unless deep or not good window, operator preference
Content:
Anechoic (nothing in there, looks all Fluid- consider urinoma (collection of urine)
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black) or Fluid filled
Scattered echoes/debris Turboid- thin pus (more turbulence)
Swirling material Thick fluid- debris in pus
Diffuse collection- with gas Organized abscess or phlegmon (localized area of
infection that starts to get walled off, chronic)
Simple collection- one single wall Requires single drain
Loculated-thin walls (divided in smaller
section)
Single drain (streptokinase: once it enters in, it
breaks down the walls, easier to drain through one
access point)
Loculated –thick walls Multiple drains (streptokinase): don’t have to rely
on one single drain
Patient Prep
oAssess/correct coagulopathies
INR: some cases where Dr. won’t care (if abscess not associated with an organ)
oAntibiotics
oConsent/procedural pause
oEquipment selection
Size 6 - 8 fr - clear fluid
8 -10 fr - thin pus
10 -12 fr - thick pus
12 - 22 fr - collections plus debris
(most are pigtail)
Sump drainage catheters:
have a second lumen for passage of air to the distal tip
for aspiration and drainage of very viscous collection
Thicker in diameter, large holes on size and the end, has a line inside,
has a lumen so the air move through it
Thick collection of pus, if the pus gets stuck in the end holes, so they
have a little vent to come in at the same time as content is getting
sucked out so the catheter is clear
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Drain these because antibiotics won"t do anything: no blood supply, the antibiotics will never get there. Symptoms of acute inflammation systemic: mild fever, malaise, fatigue, headache, loss of appetite, if infection cause the inflammation: severe fever (will limit the growth of the microorganism) Old people don"t have good temp regulation. Locations: retroperitoneal, pelvis, organ: liver (amebic: infections from microorganisms from things you eat), pancreas, spleen, renal, bowel (enteric): May cause abscess because broken skin lesions (bacteria can get in, bowel become inflamed/sticky): Crohns (can get abscesses when they stick the two good ends together) Ulcerative colitis/ diverticular: subphrenic right/left: post surgery, subdiaphragmatic: difficult to access (often from pancreatic/gastric/biliary surgery) Modality: us unless deep or not good window, operator preference. Fluid- consider urinoma (collection of urine) black) or fluid filled. Organized abscess or phlegmon (localized area of infection that starts to get walled off, chronic)
