Which clinical findings are characteristic of GI or GU infection in bacterial sepsis?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The patient may have a history of antecedent conditions predisposing to perforation or abscess. In many cases, the history is critical for diagnosis. Abdominal findings on physical examination may be absent or unimpressive.

  • Patients with an intra-abdominal or pelvic source of infection usually have a history of antecedent conditions that predispose to perforation or abscess (eg, chronic or retrocecal subacute appendicitis, diverticulitis, Crohn disease, previous abdominal surgery, or cholecystitis).
  • Diffuse abdominal pain may suggest pancreatitis or generalized peritonitis, whereas right upper abdominal quadrant (RUQ) tenderness may suggest a biliary tract etiology (eg, cholecystitis, cholangitis), and tenderness in the right lower abdominal quadrant (RLQ) suggests appendicitis or Crohn disease. Discrete tenderness over the left lower abdominal quadrant suggests diverticulitis, particularly in elderly patients.
  • A rectal examination may reveal exquisite tenderness caused by a prostatic abscess or, more commonly, an enlarged noninflamed prostate suggestive of prostatitis.
  • A urinary tract source is suggested by an antecedent history of pyelonephritis, stone disease, congenital abnormal collecting system, prostatic hypertrophy, or previous operations or procedures involving the prostate or kidneys. [32, 33] Costovertebral angle tenderness with a fever suggests acute pyelonephritis. Subacute or chronic pyelonephritis may manifest as only mild tenderness.

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