Abdominal cavity

Abdominal sepsis

According to modern concepts abdominal sepsis is a systemic inflammatory response of the body in response to the development of the original destructive (inflammatory) and secondary infection in the organs with different localization in the abdominal cavity and / or retroperitoneal space [2]. Possible consequence of such a universal reaction as abdominal infections, and in the sterile necrosis (eg, pancreatic necrosis) is the formation of multiple organ failure of various severity and sepsis, including pancreatic shock. The source of infection during abdominal sepsis may not always be adequately remedied or delimited at one stage. In this regard, the selection of peritoneal, pancreatogenic and intestinal forms of abdominal sepsis is dictated by the following features of their development, diagnosis and treatment [2]:

Abdominal sepsis often occurs when multifocus, large-scale and / or common sources of degradation and infection in the abdominal cavity and / or retroperitoneal space, where the topography is brand viagra difficult to perform a perfect surgery.

There are long synchronous (abdominal cavity, gastrointestinal tract, the retroperitoneal space) and stretched in time metachronous (purulent wound pneumonic focus, pressure sores, catheters, sutures, swabs) sources of endogenous intoxication in abdominal sepsis.

Multiple sources of infection in all forms of abdominal sepsis have a powerful potential of intoxication.

Foci of destruction and infection with abdominal sepsis are characterized as manifest clinical course, and occult forms.

Significant difficulties of differential diagnosis between abacterial inflammatory and purulent processes (such as pancreatic necrosis, drug-disease and other systemic diseases).

The rapid development of potentially fatal manifestations of sepsis, septic shock and MODS nekorrigiruemoy.

Mandatory component of a treatment program of abdominal sepsis is timely visual disturbances and adequate antibiotic therapy.

Numerous operational and anesthesiology-reanimatologicheskie benefits are extremely aggressive interventions for extremely heavy contingent of patients with complicated intra-abdominal infection.

In this context, competent and individual antibiotic therapy, intensive care and anesthetic are also important components of a treatment program than surgery. The strategic objective is to ensure that patient survival to a point where surgical and drug rehabilitation will focus a crucial effect on the dynamics of complicated intra-abdominal infections.

Objective assessment of severity and prognosis of patients with abdominal sepsis

Abdominal sepsis in patients with complicated intra-abdominal infection manifested clinical signs of systemic inflammatory response syndrome, which include sufficiently clear symptoms of sepsis, severe sepsis and septic shock [4]. Objective assessment of severity of the condition of patients with abdominal sepsis is needed to study promising areas of medical tactics, determine the amount and intensity of therapy, as well as to evaluate the prognosis. Assessment of the severity of the patients with intra-abdominal infection is included as a mandatory criteria for the study of the efficacy of antibiotics, as reflected in the regulations in Europe and the USA [6].

The most widely used system of integral evaluation of the severity of the patient with surgical infections: APACHE II (1985), and APACHE III (1991) (USA) and SAPS (France). Great practical interest are two systems that are specifically designed to assess the condition of patients with sepsis and MODS: MODS (Canada) and SOFA (Belgium). Compared with the SAPS, APACHE II scale for abdominal sepsis has a higher sensitivity. Scale of assessment of multiple organ dysfunction SOFA is simpler to use than the scale of MODS.

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