II. Definitions
- Complicated Abdominal Infection
- Intraabdominal infection that spreads beyond its origin to cause peritonitis with or with abscess
III. Causes
- Acute Appendicitis
- Acute Cholecystitis
- Acute Cholangitis
- Acute Diverticulitis
- Abdominal abscess
- Secondary bowel perforation
- Acute necrotizing peritonitis
IV. Findings
V. Labs
-
Blood Culture Indications
- Sepsis
- Fever AND Hypotension, Tachypnea or Delirium
- Antibiotic Resistance risk factors
- High local Antibiotic Resistance to common empiric Antibiotics
- Personal history of resistant infection or colonization
- Antibiotic use in past 90 days
- Older age
- Immunocompromised status
- Significant comorbidity
- Health Care Associated Infection
- Intraabdominal Fluid Culture (by fluid inoculation) Indications
- Planned source control procedure for Complicated Intraabdominal Infection
- Consider in Immunocompromised patients
- Consider when complicated disease is suspected during surgery
VI. Imaging: First-Line Studies
- See Abdominal Pain Evaluation
-
Appendicitis
- Children: Appendix Ultrasound
- Pregnancy: MRI or Ultrasound
- Non-Pregnant Adults: CT Abdomen with IV Contrast
- Cholecystitis or Cholangitis
-
Diverticulitis
- Pregnancy: MRI (or Ultrasound)
- Non-Pregnant Adults: CT Abdomen with IV Contrast
- Intraabdominal abscess
- Children: Ultrasound
- Pregnancy: MRI or Ultrasound
- Non-Pregnant Adults: CT Abdomen with IV Contrast
VII. Management
- See Acute Abdominal Pain
- See Acute Pelvic Pain
- See Pediatric Abdominal Pain
- See Abdominal Pain in Older Adults
- See specific conditions (e.g. Appendicitis, Acute Cholecystitis, acute Diverticulitis) for Antibiotic selection
VIII. Prognosis
- APACHE 2 Score
- Calculate in first 24 hours of hospitalization (Recommended by IDSA)
- Alternatives to APACHE 2 Score
- APACHE 4 has replaced the APACHE 2 Score and is best performed via calculators
- APACHE 4 Calculator: Intensive Care network calculator