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داخلشکمی
Some patients, especially patients with extensive intra-abdominal surgery or injury, may require a CT scan to rule out intra-abdominal abscess as a cause of the intolerance.
More than 30 years ago, a landmark article examining the relationship between cirrhosis, abdominal surgery, and outcomes demon- strated mortality rates approaching 80% in patients with cirrhosis and a prothrombin time more than 2.5 seconds longer than in control subjects who underwent cholecystectomy. ftese fatalities were attributable to intra-abdominal hemorrhage, progressive hepatic and renal failure, and upper gastrointestinal hemorrhage resulting from portal hypertension.
Decom- pensated liver failure and worsening ascites can lead to respiratory failure as a result of increased intra-abdominal pressure, and diure- sis, paracentesis, and transjugular intrahepatic portosystemic shunt may be required in extreme cases.
As is the case in blunt trauma, the evaluation of the abdomen is most challenging because the potential sources here are almost too numerous to list; in addition to infections resulting from recent operations or injury, the patient may be at risk for common intra-abdominal processes such as appendicitis.
Anastomotic breakdown, intra-abdominal abscess, infectious colitis, and acal- culous cholecystitis are some of the more common causes of intra-abdominal infection, and patients should be approached the same methodical way as ICU patients with fever-a thorough consideration of potential sources, followed by a focused examina- tion.
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