Peritonitis and Intra-abdominal Abscess – Pelvic and Sub-phrenic


Treatment of intra-abdominal infections is without doubt one of the most common and important challenges for surgeons generally and for those who work in low-income countries, in particular. Despite the development of much ancillary diagnostic technology, the diagnosis of peritonitis is still dependent on clinical criteria. Operative management, which may require repeated laparotomies, may tax the skills of the most experienced surgeon.

A multi-disciplinary approach to intensive care support of the critically ill patient may be as important to survival as surgery. Controlling the source of infection, removing contamination by peritoneal lavage, antibiotics and physiologic support remain the chief modalities of treatment. (2) Intra-abdominal infections comprise a) infections of specific organ systems, eg. appendicitis, and cholecystitis; b) peritonitis resulting from extension of infection into the general peritoneal cavity and c) intra-abdominal abscesses which result from the extension of inflammation beyond the viscus and from incompletely resolved peritonitis. (3) The latter two entities comprise the subject of this Review.

The Risk Factors and Symptoms of Vitamin B6 Deficiency

Vitamin B6 Deficiency Symptoms

Vitamin B6 (Pyridoxine) has many health benefits. Scientific evidence shows that vitamin B6 may help prevent coronary heart disease by helping reduce blood levels of the animo acid homocysteine. Studies show B6 is also beneficial in alleviating mood swings and depression, PMS, asthma and fatigue.

Symptoms of Vitamin B6 Deficiency

A deficiency of vitamin B6 is rare as this vitamin is readily available in many food sources. Symptoms of vitamin B6 deficiency may include skin disorders and inflammation of the tongue and mucous membranes of the mouth. In addition, a deficiency of vitamin B6 may cause dizziness, weakness and anemia. Convulsions may also occur, especially in infants.

Vitamin B6 also helps make the neurotransmitters serotonin, norepinephrine and dopamine, which help balance moods. Vitamin B6 has long been known as being beneficial for mood swings and depression. Depression, irritability, and mood swings may be indicative of a deficiency of vitamin B6.

Recommended Daily Allowances and B6-Rich Foods

Vitamin B6 Sources

Vitamin B6 is found in a variety of foods, though most of them contain a low level of this nutrient. The richest food sources of B6 are meats such as beef, liver, pork and poultry. Eggs, peanuts, peas, spinach, walnuts, and wheat germ are also significant sources. Dairy products and most fruits and vegetables contain a small amount of vitamin B6, but are not a rich source.

The Optimal Daily Allowance for vitamin B6 for adults is four to 10 milligrams. While it is possible to get enough vitamin B6 through diet alone, most individuals fail to reach the recommended daily allowance without taking a supplement. The nutrient is generally safe up to 500 milligrams a day. It is important not to take excessive amounts of vitamin B6. Toxicity may cause neurological problems such as skin rash, numbness in the hands and feet and difficulty walking.

Who is at Risk for Vitamin B6 Deficiency?

Certain lifestyle choices, such as drinking or taking oral contraceptives, may affect the amount of vitamin B6 the body is able to absorb.

Individuals who many be at risk of a vitamin B6 deficiency include:

  • oral contraceptive users
  • heavy drinkers
  • pregnant or breast-feeding women
  • people on high protein diets
  • people taking certain medications such as isoniazid, hydralazine, or penicillamine

Though it is possible to consume the Optimal Daily Allowance of vitamin B6 through diet alone, many people, especially those at risk, might benefit by taking a daily supplement.

The Serious Consequences of Antibiotics Misuse

The Serious Consequences of Antibiotics MisusePenicillin ,which was the first antibiotic, now joins over 100 antibiotics commonly prescribed to treat bacterial infections. These drugs work to kill and inhibit further growth of bacteria. They are not effective treatment for fighting viruses or fungal infections. Antibiotics are prescribed for bacterial infections and should never be taken for other types of infections. Never save unused antibiotics for later use or take antibiotics that have been prescribed for someone else. Misuse of antibiotics causes serious consequences.

Development of Drug-Resistant Infections

The misuse of antibiotics results in the increased risk of drug-resistant infections. This means that the antibiotic is no longer effective against the disease-causing bacteria. The staff of the Mayo Clinic cite the recent spread of MRSA or methicillin-resistant Staphylococcus aureus. This infection was once confined to hospitalized patients. Now a new strain of the bacteria has become prevalent and has infected healthy people in the general population. Drug-resistant infections are more difficult to treat, have a prolonged course of treatment and raise the cost of health care. Health care costs increase because of the need for more doctor’s visits, possible hospitalization and more expensive and toxic medications. Death is a consequence of certain drug-resistant infections. Antibiotic-resistant bacteria poses a global health treat since infectious bacteria adapt quickly. This presents the challenge to develop new antibiotics and treatments to keep pace with the new strains of bacteria.

Promoting Bacterial Overgrowth

Antibiotics Misuse and Bacterial OvergrowthOne example of bacterial overgrowth attributed to antibiotic misuse is a new strain of Clostridum difficile. This bacterium causes diarrhea and serious intestinal conditions such as colitis. In 2000, a new clindamycin-resistant strain of Clostridum difficile was responsible for an outbreak of diarrhea in hospitals in the United States. Clostridum difficile diarrhea has long been associated with antibiotic use. Overuse of antibiotics suppresses the normal intestinal bacteria that inhibit the overgrowth of pathogenic microorganisms. According to the staff of the Mayo Clinic, the risk of susceptibility increases with recent use of broad spectrum antibiotics that treat a wide range of bacteria, use of multiple antibiotics and prolonged use. Preventative measures against contracting the illness include proper hand washing and hygiene and avoidance of unnecessary use of antibiotics.

Jeopardizing the Health of Others

Antibiotics should be taken exactly as prescribed by a physician. Never stop taking the medication a few days early simply because you feel better. A full course of antibiotic therapy is the only effective means of killing all of the harmful bacteria. A shortened course destroys only the most vulnerable bacteria and allows the relatively resistant bacteria to survive. Consequently, the infected person spreads the surviving bacteria to other people with whom he comes in contact.