PEMICU 5

CANTIKA MONICA
405200189
13
LI 1
MM. Infeksi Akut Abdomen (Definisi, Etiologi, Patofisiologi, Tanda Dan Gejala,
Faktor Resiko, PF Dan PP, Tatalaksana Farmako Dan Non Farmako, Komplikasi,
KIE)
PERITONITIS
Acute Peritonitis
• Acute peritonitis, or inflammation
of the visceral and parietal
peritoneum , is most often but not
always infectious in origin, resulting
from perforation of a hollow viscus.
• when a specific intraabdominal
source cannot be identified 
secondary peritonitis.
• Secondary peritonitis most
commonly results from perforation
of the appendix, colonic diverticuli,
or the stomach and duodenum.
• Infective organisms may contaminate the peritoneal
cavity after spillage from a hollow viscus, a
penetrating wound of the abdominal wall, or
introduction of a foreign object (peritoneal dialysis
catheter or port that becomes infected)
• Over 90% of the cases of primary or spontaneous
bacterial peritonitis occur in patients with ascites or
hypoproteinemia (<1 g/L).
• Aseptic peritonitis is most commonly caused by the
abnormal presence of physiologic fluids like gastric
juice, bile, pancreatic enzymes, blood, or urine.
• It can also be caused by the effects of normally sterile
foreign bodies like surgical sponges or instruments.
Sign and Symptoms
• Typically severe, abdominal pain with tenderness and fever.
• Bowel sounds are usually absent to hypoactive.
• Most patients present with tachycardia and signs of volume
depletion with hypotension.
• Laboratory testing typically reveals a significant
leukocytosis, and patients may be severely acidotic.
• Radiographic studies may show dilatation of the bowel and
associated bowel wall edema.
• Free air, or other evidence of leakage, requires attention
and could represent a surgical emergency.
Risk Factors
• Peritoneal dialysis Peritonitis can occur in people
undergoing peritoneal dialysis therapy.
• Other medical conditionsThe following medical
conditions, among others, increase your risk of
developing peritonitis: liver cirrhosis, appendicitis,
Crohn's disease, stomach ulcers, diverticulitis and
pancreatitis.
• History of peritonitisOnce you've had peritonitis,
your risk of developing it again may be higher than it
is for someone who has never had peritonitis.
Treatment
Treatment depends on correcting any electrolyte
abnormalities, restoration of fluid volume and
stabilization of the cardiovascular system, appropriate
antibiotic therapy, and surgical correction of any
underlying abnormalities. The general principles guiding
the treatment of infections are four fold, as follow:
• Control the infectious source
• Eliminate bacteria and toxins
• Maintain organ system function
• Control the inflammatory process
APPENDICITIS
Appendicitis
• Appendicitis is inflammation of the vermiform appendix.
• The cause of appendicitis is usually from an obstruction
of the appendiceal lumen. This can be from an
appendicolith (stone of the appendix).
• Appendicitis occurs most often between the ages of 5
and 45
• Males have a slightly higher predisposition of developing
acute appendicitis compared to females, with a lifetime
incidence of 8.6% for men and 6.7 % for women.

https://www.ncbi.nlm.nih.gov/books/NBK493193/
Sign and Symptom
• Abdominal pain: Most common symptom
• Nausea: 61-92% of patients
• Anorexia: 74-78% of patients
• Vomiting: Nearly always follows the onset of pain; vomiting that
precedes pain suggests intestinal obstruction
• Diarrhea or constipation: As many as 18% of patients

https://emedicine.medscape.com/article/773895-overview
Physical examination
• Rebound tenderness, pain on percussion, rigidity, and
guarding: Most specific finding
• RLQ tenderness: Present in 96% of patients, but nonspecific
• Left lower quadrant (LLQ) tenderness: May be the major
manifestation in patients with situs inversus or in patients
with a lengthy appendix that extends into the LLQ
• Male infants and children occasionally present with an
inflamed hemiscrotum
• In pregnant women, RLQ pain and tenderness dominate in
the first trimester, but in the latter half of pregnancy, right
upper quadrant (RUQ) or right flank pain may occur

https://emedicine.medscape.com/article/773895-overview
Diagnosis
• The following laboratory tests do not have findings specific
for appendicitis, but they may be helpful to confirm diagnosis
in patients with an atypical presentation:
• CBC
• C-reactive protein (CRP)
• Liver and pancreatic function tests
• Urinalysis (for differentiating appendicitis from urinary tract
conditions)
• Urinary beta-hCG (for differentiating appendicitis from early
ectopic pregnancy in women of childbearing age)
• Urinary 5-hydroxyindoleacetic acid (5-HIAA)

https://emedicine.medscape.com/article/773895-overview
Differential diagnosis
• Crohn ileitis, mesenteric adenitis, mittelschmerz, salpingitis, ruptured
ovarian cyst, ectopic pregnancy, tubal-ovarian
abscess, musculoskeletal disorders, endometriosis, pelvic
inflammatory disease, gastroenteritis, right-sided colitis, renal colic,
kidney stones, irritable bowel disease, testicular
torsion, ovarian torsion, round ligament syndrome, epididymitis, and
other nondescript gastroenterological issues.

https://www.ncbi.nlm.nih.gov/books/NBK493193/
Treatment
• open or laparoscopic appendectomy; treatment delay increases mortality.
• A contraindication to appendectomy : IBD involving the cecum. caecum is normal, the appendix should be removed.
• IV antibiotics during appendectomy(Cefotetan and cefoxitin seem to be the best choices of antibiotics)
• nonperforated appendicitis : no further antibiotics are required.
• perforated appendicitis : antibiotics should be continued until the patient's temperature and WBC count have
normalized or continued for a fixed course.
3 treatment categories:
• Phlegmon or a small abscess
• Larger well-defined abscess
• Multicompartmental abscess

https://emedicine.medscape.com/article/773895-overview
Complication
Complications of appendicitis may include
• wound infection
• Dehiscence
• bowel obstruction
• abdominal/pelvic abscess
• death.

https://emedicine.medscape.com/article/773895-overview
PERFORASI
Intestinal Perforation
• Upper-bowel perforation can be described as either free
or contained. Free perforation occurs when bowel
contents spill freely into the abdominal cavity, causing
diffuse peritonitis (eg, duodenal or gastric perforation).
Contained perforation occurs when a full-thickness hole is
created by an ulcer, but free spillage is prevented because
contiguous organs wall off the area (as occurs, for
example, when a duodenal ulcer penetrates into the
pancreas).
• Lower-bowel perforation (eg, in patients with acute
diverticulitis or acute appendicitis) results in free
intraperitoneal contamination
Etiology
There are ultimately four mechanisms that can lead to a perforation of
the intestinal tract:
• Ischemia (bowel obstruction, necrosis)
• Infection (appendicitis, diverticulitis)
• Erosion (malignancy, ulcerative disease)
• Physical disruption (trauma, iatrogenic injury)
Some Causes of GI Tract Perforation
Classification
Sign and Symptoms
• Tachycardia
• Fever
• Abdominal tenderness 
• Bowel sounds are usually absent
GASTROINTESTINAL
PERFORATION
DIAGNOSIS LABORATORY
• Pain by: • Complete blood cell
– Movement : count  WBC 
peritonitis inflammation/infection
– Meals : peptic • Coagulation panel
ulceration • Electrolyte panel
• Higher risk: (potassium, chloride,
– Peptic ulcer disease bicarbonate, creatinin
– Cancer • Liver function test
– Diverticulosis • Urinalysis
– On chronic high-dose • Lipase/amylase
nonsteroidal anti- • Arterial blood gas
inflammatory drugs • Serum lactate level
– corticosteroids

LANGEL, J. T.,et.al. MED CLIN N AM 92 (2008) p599-625

GASTROINTESTINAL
PERFORATION
RADIOLOGY TREATMENT
• Upright chest • Immediate surgery
radiograph • For a perforated
• Upright and supine duodenal ulcer,may
abdominal radiographs include:
• Plain abdominal – a highly selective
radiograph vagotomy, a truncal
• Lateral decubitus vagotomy and
pyloroplasty, or
radiograph
vagotomy and
• Helical CT antrectomy.
• USG
• MRI

LANGEL, J. T.,et.al. MED CLIN N AM 92 (2008) p599-625

Perforation
Prognosis
• Surgery is usually successful
• However, the success of surgery depends on how severe the perforation is, and for how long it was present
before treatment

Complication
• abdominal abscess or peritonitis
• sepsis

https://www.nlm.nih.gov/medlineplus/ency/article/0
00958.htm
LI 2
MM. Obstruksi Akut Abdomen (Definisi, Etiologi, Patofisiologi, Tanda Dan Gejala,
Faktor Resiko, PF Dan PP, Tatalaksana Farmako Dan Non Farmako, Komplikasi,
KIE)
INTUSUSEPSI
INTUSSUSCEPTION
Definition The sliding of one part of the intestine into another

Epidemiology • The male-to-female ratio is approximately 3:1.

With advancing age, gender difference becomes
marked; in patients older than 4 years, the male-
to-female ratio is 8:1
• Intussusception is the most common cause of
intestinal obstruction in patients aged 5 months
to 3 years
• In Great Britain, incidence varies from 1.6-4 cases
per 1000 live births
Etiology • The cause of intussusception is not known, although viral
infections may be responsible in some cases
• Sometimes a lymph node, polyp, or tumor can trigger the
problem
• The older the child, the more likely such a trigger will be found
Risk Factors • Age
• Sex
• Abnormal intestinal formation at birth
• A prior history of intussusception
• AIDS

Sign and • The first sign of intussusception is usually sudden, loud crying
Symptoms caused by abdominal pain  the pain is colicky and not
continuous (intermittent), but it comes back often, increasing in
both intensity and duration
• An infant with severe abdominal pain may draw the knees to the
chest while crying
• Bloody, mucus-like bowel movement
• Fever
• Shock
• Stool mixed with blood and mucus
• Vomiting
Clinical Assesment • Upon physical examination, the patient is usually chubby and in good
health
• The infant can be pale, diaphoretic, and hypotensive if shock has
occurred
• The hallmark physical findings in intussusception are a right
hypochondrium sausage-shaped mass and emptiness in the right lower
quadrant (Dance sign). This mass is hard to detect and is best palpated
between spasms of colic, when the infant is quiet
• Abdominal distention frequently is found if obstruction is complete
Treatment Surgery
• Extremely ill patients
• Patients with evidence of bowel perforation
• Patients whom hydrostatic or pneumatic reduction has been
unsuccessful

Complication • A hole (perforation) is a serious complication due to risk of infection

• If not treated, intussusception is almost always fatal for infants and
young children

Prognosis • The outcome is good with early treatment

• There is a risk the condition will come back
Ileus Paralitik & Obstruksi
ILEUS
• DEFINITION
is a term for a difficulty of intestine passage.
• Ileus is divided into two:
• Ileus obstruction caused by an obstruction.
• Ileus paralytic caused by nerve problems.
 Ileus Obstruction

• Etiology
- Mechanic
Ex : adhesion, hernia, carcinoma
- Non mechanic
Ex : paralytic obstruction
Physical Examination
• Hyperactive bowel to overcome the obstruction
(early)  Hypoactive bowel sounds
• Proper genitourinary and pelvic examinations are
essential
• Look for the following during rectal examination:
• Gross or occult blood, which suggests late strangulation or
malignancy
• Masses, which suggest obturator hernia
• Check for symptoms commonly believed to be more
diagnostic of intestinal ischemia, including the
following:
• Fever (temperature >100°F)
• Tachycardia (>100 beats/min)
• Peritoneal signs
Clinical Feature
• cramping midabdominal pain
• Vomiting more profuse the
higher the obstruction
• Obstipation and failure to
pass gas
• Hyperactive bowel sound
Treatment Prognosis
• Non-Farmacologic :
• Nasogastric • Most intestinal obstructions
tube can be corrected with prompt
• Rectal tube treatment and the affected
• Intravenous
fluids
child will recover without
• Repair the complications.
hernia to • Untreated intestinal
correct the obstructions can be fatal,
obstruction
however.
• Surgery 
complete
• The mortality rate for
obstructions unsuccessfully treated infants
• Farmacologic : is 1–2 percent.
• Antibiotics :
pre and post
operation
Complication
• Dehydration  Kidney failure (severe dehydration)
• Irregular heartbeat
• Shock
• Systemic infection from perforation of the bowel

Prevention
• Most cases of intestinal obstruction are not preventable.
• Surgery to remove tumors or polyps in the intestines helps
prevent recurrences.
The Difference between Paralytic Ileus
and Obstructive Ileus
Paralytic Ileus Obstructive Ileus

• Bowel sounds • Bowel sounds

minimal hyperactive

• Air Fluid level • Air fluid level

provides line up provides a

• Not accompanied stepladder

by a paroxysmal • Accompanied by a
colicky abdominal paroxysmal colicky
pain abdominal pain
Hernia Inguinalis, Umbilical (3a),
Reponible and irreponible (2),
Strangulated and Incarcerated (3b)
HERNIA
• Hernia: protrusion of abdominal contents through the fascia of abdominal
wall
• Hernia always contain a portion of peritoneal sac & may contain viscera;
usually small bowel & omentum
• Hernia can no longer be reduced  incarcerated
• Strangulation when visceral contents become twisted & entrapped by
narrow opening
COMMON TYPES OF ABDOMINAL
WALL HERNIAS
Femoral hernias
• Femoral hernias account
around 5% of all abdominal
hernias
• Women > men
• highest in middle-aged and
elderly women
• They are rare in children.
• Diagnosis is often difficult
• In elderly women the incidence The anatomy of the femoral
of femoral hernia approaches canal:
• anterior border: inguinal
that of inguinal hernia ligament
• posterior border: pectineal
ligament
• medial border: lacunar
ligament
• lateral border: femoral vein.
 PRESENTATION OF FEMORAL
HERNIA

• Lump in the groin, lateral and inferior to

the pubic tubercle
• Large hernia may bulge over the
inguinal ligament and make differential
diagnosis difficult.
• Appears or swells on coughing or
straining
• reduces in size or disappears when
relaxed or supine
• It may be possible to reduce the hernia.
• There may be associated lower
abdominal pain if incarceration occurs.
INCISIONAL HERNIAS
• Incisional hernias
• Risk of any abdominal surgery and is estimated to occur in 15% of
abdominal operations
• They are caused essentially by failure of the wound to heal but are
probably the result of multiple patient and technical factors.
EPIGASTRIC HERNIAS
• ~ mid-line above the umbilicus in the
linea alba.
• Prevalence is estimated at 10%,
accounting for between 1.6-3.6% of all
abdominal hernias
• Most common in men within the ages of
20-50 years
• Multiple hernias may be present
• Usually asymptomatic, but can present
with epigastric pain varying from mild, to
severe and penetrating.
• may be accompanied by bloating,
nausea and vomiting, often after meals.
• Small hernias may be tender.
• The hernia can be made to bulge by
asking the patient to strain
UMBILICAL HERNIAS
• 10-30% of all hernias
• They can be broadly categorised into the following groups:
• Congenital hernia (also called omphalocele) - can be further subdivided into
• fetal (occurring after 8 weeks in utero) and
• embryonic (occurring before eight weeks in utero and may be
associated with herniation of other abdominal cavity organs)
• Infantile hernia - associated with prematurity; it usually spontaneously
resolves.
• Adult umbilical hernia - 90% of these are acquired
• eg, in women they are associated with multiple pregnancies and difficult
labour, but they are also found in cases of abdominal swelling - eg,
ascites and obesity.
• They result in both high levels of mortality and morbidity.
• Hernia gradually enlarges and may be multiloculated (multiple small cavities)
• Sac normally contains omentum ± bowel.
• May present with pain on coughing or straining, or an ache or dragging sensation if
large.

Rull G, Knott L. Abdominal wall hernias. Available from: http://patient.info/doctor/abdominal-wall-hernias. Last

RARE HERNIAS IN ADULTS
• Spigellian: hernia through line semilunaris muscle
• Littre’s: hernia sac contains Meckel diverticulum
• 50% inguinal, 20% femoral, 20% umbilical, 10% miscellaneous location
• Lumbar or dorsal
• Obturator canal: mainly in elderly woman
• Perineal: after surgery
• Sciatic: through greater sciatic foramen + incarceration or strangulation of
bowel
• Sportsman’s: Tear occur at external oblique
• Traumatic: blunt trauma + pain, bruising, buldge
INCARCERATED HERNIA
• Contents of hernia sac cannot be reduced into abdominal cavity
• Contained structures, include:
• Small bowel
• Appendix
• Omentum
• Colon
• Meckel diverticulum (rarely)
• In girls: ovary, fallopian tube or both
• Rarely: uterus in infants can also be pulled into sac
INCARCERATED HERNIA
• Signs and symptoms of a strangulated hernia include:
• Nausea, vomiting or both
• Fever
• Sudden pain that quickly intensifies
• A hernia bulge that turns red, purple or dark
• Inability to move your bowels or pass gas
SYMPTOMS OF INCARCERATED
HERNIA
• Irritability
• Pain in the groin & abdomen
• Abdominal distension
• Vomiting
• Tense, non fluctuant mass in inguinal region
• Can extend down to scrotum & labia majora
• Mass is well defined, may be tender, does not
reduce
• Onset of ischemic changes  pain intensifies
 vomiting becomes bilious is feculent
• Blood noted in stools
• Mass: tender often edema & erythema
Nelson textbook of pediatrics (2011)
overlying skkin
• Fever
• Signs of intestinal obstruction
• Testes maybe swollen or normal & hard on
affected side
• venous congestion resulting from compression
of spermatic veins & lymphatic channels at
inguinal ring by tightly strangulated hernia mass
• Abdominal radiographs: features of partial
or complete intestinal obstruction; gas w/in
incarcerated bowel segments may seen
below inguinal ligament or w/in scrotum
• Strangulated hernia: tightly constricted in its passage
through inguinal canal  hernia contents become
ischemic or gangrenous
• Incarceration may be tolerated in adults for years
• Most non-reducible inguinal hernias in children
rapidly progress to strangulation w/ potential infarction
of hernia contents (if not treated)
Herniated
viscera passes
Inguinal canal external ring
through internal
ring

further increase impaired

swelling of
compression in lymphatic &
herniated viscera
inguinal canal venous drainage

total occlusion of
arterial supply to
trapped viscera
• Testis is also at risk of ischemia due to compression of spermatic cord
structures by strangulated hernia
• In girls: herniation of ovary at risk of strangulation & torsion
EPIDEMIOLOGY
• Incidence of incarceration of inguinal hernia ~12-17%
• 2/3 incarcerated hernias occur in 1st year of life
• >> risk in infancy (25-30% <6 mo of age)
• Incidence of incarceration < in premature infants (reason unclear)
INGUINAL HERNIAS
• Protrusion of abdominal contents through the fascia of
the abdominal wall, through the internal inguinal ring
• Hernias comprise approximately 7% of all surgical
outpatient visits
• Male:female ratio of groin hernias is 8:1
• Hernias and hydroceles occur in 1-3% of full-term infants

RISK FACTORS:
• Infants: prematurity, male sex.
• Adults: male sex, obesity, constipation, chronic cough,
heavy lifting.
• Swelling in the groin that may appear with lifting and be accompanied by
sudden pain.
• Indirect hernias are more prone to cause pain in the scrotum and cause
a 'dragging sensation'.
• An impulse (increase in swelling) may be palpable on coughing.
• It may not be possible to see the hernia if it is reduced.
• If a lump is present, it may be reducible
• Congenital inguinal hernias are usually detected at birth  need urgent
outpatient referral for surgical repair
• Inguinal hernias in older children and adults usually develop gradually
but can occur suddenly with an episode of heavy lifting causing 'rupture‘
Pemeriksaan penunjang :
1. USG (ultrasonografi)
2. CT scan & MRI
2 TYPES OF INGUINAL HERNIAS
• Indirect:
• protrusion through the internal inguinal ring passes along the
inguinal canal through the abdominal wall, running laterally to the
inferior epigastric vessels.
• This is the more common form accounting for 80% of inguinal hernias,
especially in children.
• Associated with failure of the inguinal canal to close properly after passage
of the testis in utero or during the neonatal period
• Direct:
• hernia protrudes directly through a weakness in the posterior wall
of the inguinal canal, running medially to the inferior epigastric
vessels.
• It is more common in the elderly and rare in children.

https://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/
uploads/DirectVSindirect_01_1.gif
HERNIA
• Surgery
• Open surgery – where one cut is made to allow the surgeon to push
the lump back into the abdomen.
• Keyhole (laparoscopic) surgery – this is a less invasive, but more
difficult, technique where several smaller cuts are made, allowing the
surgeon to use various special instruments to repair the hernia.
HERNIA
• Herniorrhaphy (Open hernia repair)  local
anesthesia + sedation
• an incision in the groin  moves the hernia back into
the abdomenreinforces the abdominal wall with
stitches  reinforces the weak area with a synthetic
mesh (hernioplasty) to provide additional support.

http://www.mayoclinic.org/diseases-conditions/
 HERNIA
• Laparoscopic hernia repair  small incisions in your abdomen  a small tube equipped
with a laparoscope is inserted into one incision  inserts tiny instruments through
another incision to repair the hernia using synthetic mesh.

http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-
HERNIA
Complication
• The bulge can become trapped by the muscle causing pain and
discomfort.
• Strangulation can occur, reducing the blood flow to the area causing the
bulging portion to become infected and possibly die.
• If a portion of your intestine is trapped, the bowel can become blocked,
causing constipation, pain, and nausea.
Potassium Imbalance
Imbalance Pottasium
• Hyperkalemia  serum potassium
concentration >5 mEq/L, it is moderate (6 to 7
mEq/L) and severe (>7 mEq/L) hyperkalemia
that are life-threatening and require
immediate therapy.
• Hyperkalemia is most commonly seen in
patients with end-stage renal disease.
• Signs and symptoms of hyperkalemia include:
weakness, ascending paralysis, and respiratory
failure. A variety of electrocardiographic (ECG)
changes suggest hyperkalemia.

http://circ.ahajournals.org/content/
112/24_suppl/IV-121.full
 Hypercalemia
• Hyperkalemia is defined as a serum or plasma
potassium level above the upper limits of normal,
usually greater than 5.0 mEq/L to 5.5 mEq/L.
• Potassium is a chemical that is critical to the function
of nerve and muscle cells, including those in your
heart.
Etiology
• Increased Potassium Intake
• Intracellular Potassium Shifts
• Impaired Potassium Excretion
https://www.ncbi.nlm.nih.gov/books/NBK470284/
 Treatment of
Manifestation hyperkalemia

• Paralysis • Cardiac stabilization

- Calcium
• ECG features of
• Shift potassium into cells
hyperkalemia include:
- Insulin and glucose
• Small or absent P wave
- Beta-agonists
• Prolonged PR interval - Sodium bicarbonate
• Augmented R wave • Elimination of potassium
• Wide QRS from the body
• Peaked T waves - Diuretic therapy
- Hemodialysis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714047/
https://www.ncbi.nlm.nih.gov/books/NBK470284/
Hypocalemia
• Hypokalemia is an electrolyte characterized by low
serum potassium concentrations (normal range: 3.5–
5.0 mEq/L)
Cause
• Decreased potassium intake
• Transcellular shifts (increased intracellular uptake)
• Increased potassium loss (skin, gastrointestinal, and
renal losses)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/
LI 3
MM. Infeksi Umbilikus (Definisi, Etiologi, Patofisiologi, Tanda Dan Gejala, Faktor
Resiko, PF Dan PP, Tatalaksana Farmako Dan Non Farmako, Komplikasi, KIE) (4a)
OMPHALITIS
• Infection of the umbilical cord & surrounding tissues
• Disease is now rare in developed countries: advances in antisepsis & local
care of umbilical cord stump
• Home delivery & low birth weight = RF
• Usual pathogen:
• S.aureus (most common)
• group B Streptococci,
• Streptococcus pyogenes (group A),
• gram –ve enteric rods
• Children at risk: 1st 2 wks of life
PATHOPHYSIOLOGY
• Bacterial colonization follows soon after birth
• After ligation at delivery, umbilical stump undergoes necrosis (interruption
of its blood supply)  colonizing organisms may invade umbilical cord
stump & surrounding tissues
• Initial infection = cellulitis; peritonitis, liver abscess and/or sepsis may
happen in short order
CLINICAL FINDINGS
• Drainage; erythema around umbilical cord stump
• Later in course of infection: manifest signs of sepsis
• Lethargy
• Irritability
• Hypothermia or hyperthermia

• Lab studies:
• Normal in early course

• ✗ definite criteria for early infections

• Findings suggestive of omphalitis:
• Purulent, foul smelling drainage from umbilical cord + erythema of anterior
abdomen or
• Any drainage w/ erythema that completely encircles the umbilicus
• Induration & erythema of anterior abdomen wall = definite indicators of
TREATMENT
•Treatment of uncomplicated cases requires prompt antibiotic therapy
• Antibiotics are the mainstay of medical treatment of omphalitis. Antibiotics
• Aminoglycoside to cover for both gram-positive and gram-negative
organisms are used.
• The local antibiotic susceptibility patterns need to be considered in the
• initial therapy:
• ampiclox, cloxacillin, flucloxacillin, and methicillin in combination with
gentamycin.
• Metronidazole may be added when anaerobes are suspected.
• Duration of treatment is typically for 10–14 days with initial parenteral therapy
for complicated cases.
• A short antibiotic therapy of 7 days is adequate for simple uncomplicated
omphalitis
COMPLICATIONS
• Omphalitis may extend into the portal
vein  various acute complications
• requiring medical as well as surgical
interventions
• The pathophysiology of complications
of omphalitis is closely related to the
anatomy of the umbilicus.
• The infection can spread along the
umbilical artery, umbilical veins,
abdominal wall lymphatics and vessels,
and by direct spread to contiguous
areas
NECROTIZING FASCIITIS
• NF = severe complication of omphalitis
• local signs have progressed: a peau d’orange appearance, discolouration or bruising of the
skin, skin necrosis, and crepitation.

• Initially as periumbilical cellulitis  without treatment  necrosis of the skin and subcutaneous
tissue
• The scrotum is the most commonly affected by NF, but the abdominal wall may also be
involved

• Treated early, periumbilical cellulitis can be controlled by use of parenteral broad-spectrum

antibiotics.
• always include an antianaerobe (e.g., metronidazole).
• treat by prompt debridement, removing all dead and dying tissues, followed by daily dressing of
the wound.
THANK YOU