Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

6 Abscesses and Fistulas

■Nausea & vomiting

■Hiccups

■Chest pain

■Dyspnea

■Shoulder pain

Signs & Symptoms

■Tachycardia

■Abdominal tenderness

■Ileus

■Pleural effusion

■Basilar rales

tests

Basic Blood Tests

■Leukocytosis w/ left shift

■Anemia

■Nonspecific elevation of bilirubin & liver enzymes

Specific Diagnostic Tests

■Positive blood cultures

■Positive cultures from aspiration of abscess

■Most common aerobes: E coli & Enterococcus

■Most common anaerobes: Bacteroides

Imaging

■Plain abdominal & chest films: air-fluid levels in area of abscess;

elevation of right diaphragm in subphrenic abscess

■Gallium scan: useful for smaller abscess not well seen on imaging

■CT: imaging modality of choice for identification of abscess; also

allows aspiration for culture

■US: less sensitive for abdominal abscesses

■Charcoal or methylene blue: oral administration with detection in

drainage from fistula

differential diagnosis

■Necrotic tumors

management

What to Do First

■Complete diagnostic studies, particularly imaging, for localization &

aspiration