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Psoas abscess.pptx

  1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide.
  2. Introduction
  3. Introduction • The psoas muscle is a retroperitoneal organ that originates from the lateral borders of the 12th thoracic to fifth lumbar vertebrae and inserts on the lesser trochanter of the femur.
  4. Introduction • The psoas muscle lies in close proximity to many other organs, including the sigmoid colon, jejunum, appendix, ureters, aorta, renal pelvis, pancreas, iliac lymph nodes, and spine. • Infections in these organs can contiguously spread to the psoas muscle. • The psoas muscle has a rich vascular supply that is believed to predispose it to hematogenous spread from sites of occult infection.
  5. Pathophysiology
  6. Pathophysiology • Primary psoas abscess – intravenous drug users, – diabetes, – Immunosupression – renal failure. – human immunodeficiency virus (HIV).
  7. Pathophysiology • Secondary psoas abscess – Gastrointestinal • Diverticulitis, appendicitis, Crohn's disease, colorectal carcinoma, appendiceal tumor – Genitourinary • Urinary tract infection, extracorporeal shock wave lithotripsy, cancer – Musculoskeletal • Vertebral osteomyelitis, lumbar spondylodiskitis, infectious sacroiliitis, septic arthritis –
  8. Pathophysiology • Secondary psoas abscess – Other • Endocarditis, femoral artery catheterization, infected abdominal aortic aneurysm, hepatocellular carcinoma, trauma, intrauterine contraceptive device, acupuncture, spinal surgery sepsis, suppurative adenitis, long-term hemodialysis or peritoneal dialysis
  9. Bacteriology
  10. Bacteriology • Primary psoas abscess – Staphylococcus aureus – Serratia marcescens, – Pseudomonas aeruginosa, – Haemophilus aphrophilus – Proteus mirabilis.
  11. Bacteriology • Secondary psoas abscess:enteric bacteria – Escherichia coli – Streptococcus species – Enterobacter species – Salmonella enteritidis – Methicillin resistant S aureus – Mycobacterium tuberculosis – Nontuberculous mycobacteria • M kansasii • M xenopi
  12. Clinical Features:Symptoms
  13. Clinical Features:Symptoms Nonspecific. • fever • flank pain • abdominal pain • Limp • pain sometimes radiates anteriorly to the hip and thigh. • Other symptoms are nausea, malaise, and weight loss.
  14. Clinical Features:Signs
  15. Clinical Features:Signs  Posture- supine position, with the knee moderately flexed and the hip mildly externally rotated.  Psoas sign passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip. If abdominal pain results, it is a "positive psoas sign".  Tender swelling below inguinal ligament.
  16. Diagnostic Studies
  17. Diagnostic Studies • Laboratory Studies • Imaging Studies
  18. Diagnostic Studies • Laboratory Studies – Leukocytosis – elevated erythrocyte sedimentation rate (ESR) – elevated blood urea nitrogen (BUN) – Pyuria
  19. Diagnostic Studies Imaging Studies • USG • CT • Nuclear scan
  20. Management
  21. Management • Appropriate antibiotics, as well as drainage of the abscess. • CT-guided percutaneous drainage or surgical drainage
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