A patients has right subphrenic absess true is.
(C) (Drainage is through 12 ICS posteriorly) (978- Bailey & Love 26th)* If a swelling can be detected in the subcostal region or in the loin, an incision is made over the site of maximum tenderness, or over any area where oedema or redness is discovered. The parieties usually from part of the abscess wall, so that contamination of the general peritoneal cavity unlikely* If no swelling is apparent the subphrenic spaces should be explored either by an anterior subcostal approach or from behind after removal of the outer part of the 12th rib according to the position of abscess if indicated on a lateral X-ray film. With the posterior approach the pleura must not be opened and after the fibres of the diaphragm have been separated a finger is inserted beneath the diaphragm so as to explore the adjacent area.SUB PHRENIC ABSCESS* Four intraperitoneal and three extraperitoneal (perinephric) spaces in which pus may collect* Common causes of Right sub phrenic space/ Right subhepatic space- Perforating cholecystitis- Perforated duodenal ulcer- A duodenal cap' blow- out 'following gastrectomy- Appendicitis* Most common site of subphrenic space is Right subhepatic space/ Right posterior intraperitoneal *** (RutherfordMorison's Kidney pouch)* Clinical features- swinging pyrexia is usually present, sweating wasting, and anorexia, sometimes epigastric fullness and pains, pain in the shoulder on the affected side,owing to irritation of sensory fibres in the phrenic nerve, referred along the descending branches of the cervical plexus, persistent hiccup may be a presenting symptoms.* The modem management of an abscess is by radiological diagnosis using ultrasournd or CT guidance followed by drainage.Also Remember:1. Site for putting chest drain in Pleural effusion- 7th ICS midaxillary line2. Site for putting needle in spontaneous pneumothorax - 2nd ICS, midclavicular line3. Venesection of great saphenous vein- saphenous nerve4. Venesection of small saphenous vein- sural nerve5. Popcorn calcification in mammography - fibroadenoma6. Popcorn calcification - Lung hamartoma
Most comman cause is rupture of hepatic abscess
Pain in right hypochondrial that radiates to lumber and back region
Drainage is through 12th ICS posteriorly
Investigation of choice is plain x-ray
Miscellaneous