gonococcal peritonitis

淋菌性腹膜炎

WordNet

1. inflammation of the peritoneum (同)peritoneal inflammation

PrepTutorEJDIC

1. 腹膜炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/05/12 09:58:33」(JST)

wiki en

[Wiki en表示]

Fitz-Hugh–Curtis syndrome
Perihepatic adhesions

Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions. The condition is named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively.

Signs and symptoms

The major symptom and signs include an acute onset of right upper quadrant (RUQ) abdominal pain aggravated by breathing, coughing or laughing, which may be referred to the right shoulder. There is usually also tenderness on palpation of the right upper abdomen and tenderness to percussion of the lower ribs which protect the liver. Surprisingly there is often no or only minimal pelvic pain, vaginal discharge or cervical motion tenderness, which may lead to the diagnosis being missed. This may be due to infectious bacteria bypassing pelvic structures on the way to the liver capsule.

Pathophysiology

Fitz-Hugh–Curtis syndrome occurs almost exclusively in women. It is usually caused by Chlamydia trachomatis (Chlamydia) or Neisseria gonorrhoeae (Gonorrhea) though other bacteria such as Bacteroides, Gardnerella, E. coli and Streptococcus have also been found to cause Fitz-Hugh-Curtis syndrome on occasion. These bacterial pathogens cause a thinning of cervical mucus and allow bacteria from the vagina into the uterus and fallopian tubes, causing infection and inflammation. Occasionally, this inflammation can cause scar tissue to form on Glisson's capsule, a thin layer of connective tissue surrounding the liver.(Bailey&Love)

Diagnosis

Abdominal ultrasound will typically be normal. Liver function tests will typically be normal or unchanged from baseline as the infection does not involve the liver parenchyma. If a D-dimer is ordered, which it often is when there is pleuritic torso pain, it will usually be markedly elevated but other testing for pulmonary embolism will be normal. CT of the abdomen with IV contrast may show subtle enhancement of the liver capsule, but this may be missed by radiologists if they are not advised to look for it. Testing for gonorrhea and chlamydia should be performed to make the diagnosis. An endocervical or low vaginal swab should be taken to test for these organisms. Antibody testing is rarely required but may be considered if other tests are non-diagnostic and suspicion is high.

Laparoscopy is also rarely required, but may be performed when the diagnosis is uncertain and may reveal "violin string" adhesions of parietal peritoneum to liver.

Treatment

Treatment involves a course of antibiotics to cover the appropriate organisms, typically ceftriaxone plus azithromycin. Laparoscopy for lysis of adhesions may be performed for refractory pain.

Further reading

• Pregerson, Brady (2010). Quick Essentials: Emergency Medicine (4th ed.). ISBN 978-0-9761552-3-2. 
• Pregerson, D. Brady (2012). Tarascon Emergency Department Quick Reference Guide. Jones & Bartlett. ISBN 978-0-7637-8789-9. 

External links

Classification	V · T · D ICD-9-CM: 098.86, 099.56 DiseasesDB: 4843
External resources	eMedicine: med/797

• chlamydiae.com description of Perihepatitis

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. クラミジア・トラコマチス感染の治療 treatment of chlamydia trachomatis infection
• 2. 分娩後子宮内膜炎 postpartum endometritis
• 3. 子宮摘出後の膣断端離開 vaginal cuff dehiscence after hysterectomy
• 4. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
• 5. 妊娠と関連しない子宮内膜炎 endometritis unrelated to pregnancy

English Journal

• Acute gonococcal Fitz-Hugh-Curtis syndrome: a case report.

• Joshi RM, Alkhalegy AA.SourceMicrobiology Unit, Radiology Nuclear Medicine and Laboratory Center (RNMLC) YIACO Medical Co. K.S.C.C., Adan, Kuwait. drrmjoshi2002@yahoo.com
• International journal of STD & AIDS.Int J STD AIDS.2012 Mar;23(3):e39-40.
• A case of acute Fitz-Hugh-Curtis syndrome in a young woman with purulent peritonitis and acute purulent appendicitis and oophoritis is presented. Open emergency appendectomy was performed and peritoneal pus was drained. Neisseria gonorrhoeae was cultured from the peritoneal pus. The hepatic enzymes
• PMID 22581895

• Gonococcal peritonitis diagnosed post laparotomy in a 38-year-old woman: a case report.

• Wilmore SM, Reynolds CJ.SourceDepartment of Surgery, Chase Farm Hospital, Enfield, Middlesex, En2 8JL, England. swilmore@nhs.net
• Cases journal.Cases J.2009 Sep 17;2:8080.
• A 38-year-old South African lady with a background history of cervical intra-epithelial neoplasia and recent colposcopy presented to the emergency department with severe abdominal pain. Initial investigations were non-diagnostic and despite empirical antibiotic therapy the patient developed peritoni
• PMID 20181206

Japanese Journal

• 口腔及び性器淋菌感染症に対するCeftriaxone, Cefditoren投与の臨床効果

• 千村 哲朗,村山 一彦
• The Japanese Journal of Antibiotics 59(1), 29-34, 2006
• 淋菌感染症 (口腔及び性器) について性産業従事者 (CSW) を対象とし, 臨床所見とCeftriaxone (CTRX), Cefditoren (CDTR) 投与の臨床効果を検討した。淋菌検査は口腔 (DNAprobe法) 性器 (PCR法), クラミジア抗体検出 (ELSA法) によった。<BR>1. 口腔感染症群 (n=20) では, クラミジア感染 (65%), ヘルペス感 …
• NAID 130004396036

Related Pictures

---

★リンクテーブル★

リンク元

「淋菌性腹膜炎」

「淋菌性腹膜炎」

　　[★]

英

gonococcal peritonitis