etiology, pathogenesis

direct contamination from the area of local disease (peritonitis secondary eg after organ perforation), injuries, surgery (biliary tract, duodenum, stomach, anastomoses), propagation of infection from a distant place (eg appendicitis)

factors influencing fluid transfer into subphrenic area

negative pressure in the area generated during diaphragm movement during the respiratory cycle, increased intra-abdominal pressure in the lower abdomen

symptoms, signs

fever, anorexia, weight loss, unproductive cough, chest pain, dyspnea, shoulder pain. Chest - listening to rhonchi, wheezing, impaired breathing, friction murmur, percutory shortened sounds (basal atelectasis, pneumonia, pleural effusion). Abdomen - tenderness, pain, peritoneal irritation, palpable formation, wound fistula, abdominal wall distension, hypoactive intestinal sounds (paralytic ileus)

diagnostics

leukocytosis, decreased Hb, Htk, increased FW, positive blood culture, chest X-ray - (pleural effusion, increased / immobile hemidiaphragm, pneumonitis, atelectasis), abdominal X-ray - (extraintestinal air in abscess, shift of adjacent organs, dense tissue density ), ultrasound examination (helpful especially in the right abscess), CT examination

complications

propagation of the abscess into the thoracic cavity (empyema, lung abscess, pneumonia), septic condition, malnutrition, pulmonary embolism

therapy - principles

surgical evacuation and drainage, systemic antimicrobial drugs