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Rubor, Dolor, Calor, Tumor

The RUQ sucks. Or so I was always told.

Mark Crislip, MD, Infectious Diseases, 11:40PM Sep 16, 2013

The patient had a cecum resection that had an anastomotic leak. The leak was repaired, but she represented with RUQ pain, fever, and leukocytosis.

A CT shows a large abscess between the diaphragm and the liver. It is drained and grows colon bugs. The microbiology is no surprise. But why the abscess so far from the original insult?

Curtis and Fitz-Hugh noted the propensity for Gonorrhea to travel from the fallopian tubes all the way to perihepatic space. Their original descriptions make for interesting reading.

Supposedly respiration leads to a negative pressure in the the RUQ and infection and mets are sucked into the area.  The RUQ has the lowest pressure and sucks the most.

I found multiple statements to the effect that


"The location of intra-peritoneal spread of disease is influenced by gravity and the negative sub-diaphragmatic pressure caused by respiratory motion."


But I can't find the original measurements and papers that demonstrate the RUQ slurping up infectious material. Maybe my Google-fu is off. Or maybe it is as Stephen Jay Gould said.


"No scientific falsehood is more difficult to expunge than textbook dogma endlessly repeated in tabular epitome without the original data."

So if the RUQ truly sucks I can't find the proof. I am sure someone will set me straight.

Rationalization

Am Surg. 2001 Mar;67(3):243-8. What is normal intra-abdominal pressure?


A CAUSE OF ADHESIONS IN THE RIGHT UPPER QUADRANT ARTHUR H. CURTIS, M.D. JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.


ACUTE GONOCOCCIC PERITONITIS OF THE RIGHT UPPER QUADRANT IN WOMEN THOMAS FITZ-HUGH Jr., M.D. JAMA.1934;102(25):2094-2096. doi:10.1001/jama.1934.02750250020010.


Patterns of peritoneal spread of tumor in the abdomen and pelvis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650201/

About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor. I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammer. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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