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Peritonitis - Download as PowerPoint

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									Peritonitis




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Definition
• Inflammation of the peritoneum
Aetiology
  Bacterial infection – commonest organisms are
   Escherichia coli, aerobic and anaerobic streptococci,
   and the bacterioides.klebsiella pneumoniae.
   Mycobacterium tuberculosis
  Bile irritation  biliary peritonitis
  Biliary peritonitis following peptic ulcer perforation.
  Trauma, open surgery, drains
  Inflammatory bowel disease, appendicitis, ischaemic
   bowel.
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• Pelivic inflammatory disease
• Haematogenous spread e.g., septicaemia
• Pancreatitis – inflammation of the peritoneum by
  the irritant secretions from the pancreas.
Pathophysiology: -
  inflammation ,
  exudation  ascites,
  paralytic ileus,
  distension of abdomen,
  dehydration,
  respiratory embarassment due to the distension,
  septicemia
  death

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             Clinical features: -
    Localised peritonitis
•   Abdominal pain which goes on increasing
•   Fever
•   Vomiting
•   Tenderness, rebound tenderness, Rowsing’s sign.
•   Localised guarding, or rigidity.




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    Diffuse (generalized) peritonitis
•   Severe abdominal pain
•   Pain increases on moving and or breathing
•   Patient lies still
•   Tenderness and rigidity of the abdominal wall
•   Pulse rises progressively
•   The temperature may become subnormal
•   Late features:- if resolution or localisation of
    generalized peritonitis does not occur the abdomen
    remains silent and increasingly distends.
•   Circulatory failure ensues
•    cold and clammy extremities
•   Sunken eys                                        5
•   Dry tongue
• Thready (irregular) pulse,
• Drawn and anxious face (Hippocratic facies)
• Unconsciousness
  Investigations
Peritoneal diagnostic aspiration – called peritoneal
  tapping
Routine blood tests – TC, DC, ESR etc.
X-Ray abdomen
Serum amylase
Ultrasound scanning
CT scanning
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  Treatment
• General care of the patient
• Specific treatment for the cause
• Peritoneal lavage when appropriate




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        General Care of the Patient

•   Volume replacement
•   Electrolyte imbalance correction
•   Gastrointestinal deompression
•   Antibiotic therapy
•   Fluid balance chart
•   Analgesia
•   Vital system support esp. if septic shock is present

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      Complications of peritonitis


Systemic compications of peritonitis
1. bacteraemic or endotoxic shock
2. bronchopneumonia/respiratory failure
3. Renal failure
4. Bone marrow suppression
5. Multisystem failure

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     Abdominal complications of peritonitis
1.   Adhesional small bowel obstruction
2.   Paralytic ileus
3.   Residual or recurrent abscess
4.   Portal pyaemia/liver abscess
5.   Paralytic ileus

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Jejunal diverticulitis with peritonitis




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The Peritoneum




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Definition
• The peritoneum is the largest serous membrane of
  the body lining the abdominal cavity
Structure
• Consists of a closed sac, containing a small
  amount of serous fluid, within the abdominal
  cavity.
• Two layers
• The parietal layer - lines the abdominal wall
• Visceral layer – covers the organs (viscera) in the
  abdominal and pelvic cavities

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• The oragns are invaginated into
  the closed sac from above,
  below and behind so that they
  are at least partly covered by the
  visceral layer

• Pelvic organs are covered only
  on their superior surface

• The stomach and intestines
  deeply invaginated from behind
  are almost completely
  surrounded by peritoneum and
  have a double fold ( the
  mesentery).
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• The fold of peritoneum attaches them
  to the posterior abdominal wall

• The pancreas, spleen, kidneys and
  adrenal glands are invaginated from
  behind - only their anterior surfaces
  are covered by the peritoneum -
  therefore retroperitoneal

• Liver completely covered - attached
  to the diaphragm

• The main blood vessels and nerves
  pass close to the posterior abdominal
  wall and send branches to the organs
  between the two folds of peritoneum     23
• Parietal peritoneum lines the
  anterior abdominal wall
• The two layers are actually in
  contact - friction prevented by the
  presence of serous fluid secreted
  by the peritoneal cells
• Peritoneal cavity is only a potential
  cavity
• In women there is communication
  of the peritoneal cavity to the
  external atmosphere through the
  openings of the fallopian tubes (at
  fimbrial ends)
• In males the peritoneal cavity is
  completely closed.
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