Intraabdominal infection and acute abdomen
Acute abdomen refers to a heterogenous group of urgent conditions characterized by the sudden onset of severe abdominal pain. The spectrum of disease encompassed within this term may cause diagnostic difficulty, owing to the considerable diversity in the underlying etiology, which includes, among others, obstructive, inflammatory, vascular, infective, and gynecological processes. Infective intraabdominal processes in particular are a serious cause of mortality and present a unique clinical challenge due to the evolutionarily dynamic nature of the pathogens and the potential for progression of infection beyond the original infectious foci. As a result, diagnosis and management of patients with suspected intraabdominal infections is contingent on obtainment of a comprehensive history, structured evaluation, timely intervention, and prompt initiation of empiric therapy, followed by adjustments in antimicrobial therapy once the causative organism has been identified, if necessary.
Review
Acute abdomen refers to a medical emergency, arising from full health, characterized by rapid progress and potentially life threating without adequate swift treatment. The algorithm considers basic examinations, which must be performed as part of differential diagnosis, and further elaborates other procedures for correct diagnosis in this case - bowel perforation. Using the correct and incorrect answers, the microbiological diagnosis of secondary peritonitis agents is reminded. Starting from the principles of correct material collection to microbiological examination, through microscopic and subsequent culture determination of probable infectious agents and correct antimicrobial therapy given the specific pathogen. These are common acute conditions that every doctor encounters in daily practice and in the field of microbiological diagnostics are still accompanied by errors (decent wetting of the swab in the purulent content of the abdominal cavity instead of taking a tube full of pus). Due to this fact, this algorithm is a good teaching aid for future doctors.
Sources
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FLASAR, Mark H. and Eric GOLDBERG. Acute Abdominal Pain. Medical Clinics of North America [online]. 2006, 90(3), 481-503 [cit. 2021-5-16]. ISSN 00257125. Available from: doi:10.1016/j.mcna.2005.11.005
HALL, Jason, Karin HARDIMAN, Sang LEE, Amy LIGHTNER, Luca STOCCHI, Ian M. PAQUETTE, Scott R. STEELE and Daniel L. FEINGOLD. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Diseases of the Colon & Rectum [online]. 2020, 63(6), 728-747. ISSN 0012-3706. Available from: doi:10.1097/DCR.0000000000001679
GOERING, Richard V., Hazel M. DOCKRELL, Mark ZUCKERMAN, Ivan M. ROITT and Peter L. CHIODINI. Mims' Medical Microbiology. 5th ed. Philadelphia, PA: Elsevier, c2013. ISBN 978-072-3436-010.
MACALUSO, Christopher R and Robert M MCNAMARA. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine [online]. 2012, (5), 789-797. ISSN 1178-7074. Available from: doi:10.2147/IJGM.S25936
MURRAY, Patrick, Ken ROSENTHAL and Michael PFALLER. Medical Microbiology. 8th ed. Philadelphia, PA: Elsevier, 2015. ISBN 9780323299565.
SOLOMKIN, Joseph S., John E. MAZUSKI, John S. BRADLEY, et al. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clinical Infectious Diseases [online]. 2010, 50(2), 133-164 [cit. 2020-12-3]. ISSN 1537-6591. Available from: doi:10.1086/649554
