Psoas abscess: Difference between revisions
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==DDX== | ==DDX== | ||
===Right=== | |||
{{Abd DDX RLQ}} | |||
===Left=== | |||
{{Template:LLQ DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
| Line 22: | Line 25: | ||
**[[Vancomycin]] + | **[[Vancomycin]] + | ||
**One of the following | **One of the following | ||
***Piperacillin/tazobactam 3.375g, OR | ***[[Piperacillin/tazobactam]] 3.375g, OR | ||
***[[Ceftriaxone]] + Metronidazole | ***[[Ceftriaxone]] + Metronidazole | ||
*Surgical consultation | *Surgical consultation | ||
==See Also== | |||
*[[Abdominal Pain]] | |||
==Source== | ==Source== | ||
Revision as of 03:58, 27 October 2014
Background
- Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels
- S. aureus is most common pathogen (80%)
DDX
Right
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
Left
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Diagnosis
Clinical Features
- Abdominal pain radiating to hip, flank
- Pain with thigh flexion (esp against resistance)
- Limp
- Fever
- Nausea
Workup
- CT is imaging study of choice
Treatment
- Antibiotics
- Vancomycin +
- One of the following
- Piperacillin/tazobactam 3.375g, OR
- Ceftriaxone + Metronidazole
- Surgical consultation
See Also
Source
- Tintinalli