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6 results

  • 3.5.3 - Peritonitis and the Acute Abdomen

  • from Section 3.5 - Acute Gastrointestinal Failure
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 211-213

  • Summary

    Key Learning Points

    1. 1. The acute abdomen requires prompt diagnosis and management to improve patient outcomes.

    2. 2. In the critically ill adult, causes of an acute abdomen can be broadly divided into mechanical, inflammatory and vascular.

    3. 3. Peritonitis is due to infection in most cases. It may be generalised or localised, and is further divided into primary, secondary and tertiary infection.

    4. 4. Acute mesenteric ischaemia is an uncommon vascular cause of the acute abdomen but is associated with high mortality.

    5. 5. Radiological findings are useful, although the diagnosis is mainly clinical.

  • 57 - Necrotizing soft tissue and skin infections

  • from Section 9 - Infectious disease emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 375-380

  • Summary

    This chapter discusses the diagnosis, evaluation and management of esophageal perforation and mediastinitis. About a third of patients present with atypical symptoms or signs including sepsis, peritonitis, respiratory distress, fever, pneumo/hydrothorax, fulminant shock, and multi-system organ failure. Approximately 17% of esophageal perforations are diagnosed only at autopsy. 90% of patients have findings suggestive of perforation on simple chest radiography. A contrast study such as esophagography with Gastrograffin should be performed if perforation is suspected. Although barium has superior sensitivity, it causes a worsened mediastinal/peritoneal inflammatory response if a leak is present. In addition, Gastrograffin is recommended because it does not obscure visualization during endoscopy. Computed tomography (CT) of the chest and abdomen with oral contrast may better define the leak, assess complications, and exclude other diagnoses.

  • 54 - Pneumonia

  • from Section 9 - Infectious disease emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 362-366

  • Summary

    This chapter discusses the diagnosis, evaluation and management of acute mesenteric ischemia. The diagnosis should be considered in those older than 50 years, presenting with nonspecific abdominal pain and risk factors for the disease. The physician must have a high index of suspicion as the history of the disease may be difficult to obtain. The chapter lists clinical presentations of the subtypes of mesenteric ischemia. Emergent laparotomy is indicated, especially if signs of peritonitis are present. Surgery is generally the standard of care for mesenteric arterial embolism and thrombosis. Surgery is done to determine the extent of damage, to find the underlying cause, to revascularize viable bowel, and to resect infarcted bowel. Second-look procedures are often performed 24-48 hours after the initial surgery in order to restore continuity and assess extension of ischemia to ensure that at-risk or ischemic bowel is not used for the final anastomosis.

  • Ketamine and the inhibition of albumin extravasation in chemical peritonitis in rat

  • K. Hirota, H. Ishihara, A. Matsuki
  • Journal:
    European Journal of Anaesthesiology / Volume 19 / Issue 3 / March 2002
    Published online by Cambridge University Press:
    16 August 2006, pp. 173-176
    Print publication:
    March 2002

  • Background and objective: It was previously reported that topical ketamine inhibits albumin extravasation in a rat chemical peritonitis model. Using the same model, the present study investigated whether intravenous ketamine inhibited this extravasation.

    Methods: Twenty-four rats anaesthetized with pentobarbital (75 mg kg−1) were randomly assigned to two groups: ketamine and a 0.9% NaCl (saline) group (n = 12 each). Ketamine 1% or saline 0.1 mL kg−1 min−1 was given intravenously for 60 min to the respective group. After the abdomen had been opened, peritonitis was elicited by topically applying a filter paper containing 0.02 M HCl 0.07 mL onto the surface of the appendix or caecum for 5 min. Fifteen minutes after removal of the filter paper, Evans' blue dye (50 mg kg−1) was injected intravenously. The extravasated dye was colorimetrically quantified by a spectrophotometer at 620 nm.

    Results: The infusion of ketamine significantly reduced Evans' blue extravasation: 5.26 (range 4.18–6.34) μg per 100 mg tissue compared with the saline group control: 6.81 (5.93−7.69) μg per 100 mg tissue (P < 0.05).

    Conclusions: It is suggested that ketamine anaesthesia may reduce albumin extravasation in inflammatory tissues.

  • Neuropsychological Status of Patients with Peritonitis

  • D.V. Elioutine, A.S. Miltsin, S.N. Kotov
  • Journal:
    Prehospital and Disaster Medicine / Volume 16 / Issue S1 / June 2001
    Published online by Cambridge University Press:
    28 June 2012, pp. S25-S26
    Print publication:
    June 2001
    • Article
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  • Procalcitonin: a new parameter for the diagnosis of bacterial infection in the peri-operative period

  • W. Oczenski, R. D. Fitzgerald, S. Schwarz
  • Journal:
    European Journal of Anaesthesiology / Volume 15 / Issue 2 / March 1998
    Published online by Cambridge University Press:
    16 August 2006, pp. 202-209
    Print publication:
    March 1998

  • Procalcitonin, a new innovative inflammation parameter is presently being evaluated in clinical studies. It has been shown to be increased markedly in patients with severe bacteria induced inflammation, septic shock, endotoxinaemia and multiple organ failure. In contrast, severe viral infections or inflammatory reactions of non-infectious origin as well as autoimmune or allergic disorders do not or only very moderately increase procalcitonin serum levels. Because procalcitonin is observed at significantly higher concentrations in bacterial infections, it might assist differentiation between these infections and other aetiologies of critical illnesses. Furthermore, pro-calcitonin correlates with the severity of infection and sepsis and thus could serve as a useful marker for monitoring surgical high risk patients. Procalcitonin may serve as a valid and sensitive indicator for bacterial infection with important diagnostic potential in the peri-operative period and in intensive care medicine.