peritonitis rochi sfuchas
TRANSCRIPT
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PERITONITIS
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Name of participants
1.SULLY SIMKOKO2.ROCHIUS MODEST3.ALEX LIPENDELE4.PHILIP JOHN5.ALPHA KWILASA
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Outline• Introduction • Etiology• Classification• Pathophysiology• Clinical presentation• Work up • Management• Complication • Prognosis • References
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INTRODUCTION
• Peritonitis is the inflammation of the peritoneum
• The peritoneum is the serous membrane which encloses the abdominal cavity and its contents
Parietal peritoneumVisceral peritoneum
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Etiology
• InfectiousBacteria eg. E. coli, streptococcus (aerobes &
anaerobes), etcNon bacteria eg. Fungal and virus
• Non infectiousChemical peritonitis eg. gastric acid, bile and blood
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CLASSIFICATION
• Anatomical• Etiological• Pathological • Clinical
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Anatomical classification Localized peritonitis
Factors which favor localized peritonitis -compartmentalization of abdominal cavity
-pathological factor -surgical factor
Diffused/generalized peritonitisFactors
-sudden visceral perforation-vigorous peristalsis-immune compromised pt-age(infants)-poor handling of localized infection
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Etiological classificationInfectious peritonitis
-bacterial -non bacterial
Non infectious(chemical) peritonitis
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Pathological classification
Primary peritonitis-due to spontaneous bacterial invasion of
peritoneumSecondary peritonitis
-due to loss of integrity of the GIT Tertiary peritonitis
-due to persistence/ recurrence of peritonitis after adequate control of primary or secondary peritonitis
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Clinical peritonitis
Acute peritonitis-this is of sudden onset eg bacterial peritonitis
Chronic peritonitis-present with gradual onseteg TB peritonitis
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PATHOPHYSIOLOGY
Absorption of irritantStimulation/activation of immune systemLocalization of infection by host defense
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Clinical stages of peritonitis
Peritonism/irritation Reaction Diffuse peritonitis
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CLINICAL PRESENTATION
History Physical examination
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History/symptoms
Abdominal painAnorexia Nausea and vomitingFeverConstipation
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Physical examination
General examinationSystemic examination
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General examination
Shallow breathingDehydrationTachycardiaTachypnoic Febrile above 38 degree of centigrade Hypotension Toxic with ‘facies Hippocratic’ Features of septic shock
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facies Hippocratic
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Abdominal examination
Distended abdomen Failure of abdomen to move with respiration Abdominal Tenderness Muscle guarding/rigidity Rebound tenderness or Blumberg sign Decreased or no bowel sound
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WORKUP
Laboratory studies Imaging studies Diagnostic procedures
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Laboratory studies
FBP and ESRSerum electrolyteSerum createnin and blood ureaSerum amylase C-reactive proteinBlood grouping and X-matchBlood gases
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Imaging studies
Plain thoraco-abdominal X-ray (erect) Abdominal USS Abdominal CT Scan MRI
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Diagnostic procedures
Peritoneal fluid aspiration-For gram stain, culture and sensitivity
Laparoscopic investigation
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MANAGEMENT
• Principles of treatment • Modalities of treatment
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Principles of treatment
Control of source of infectionElimination of bacteria and toxinsMaintain organ system functioningTo control inflammatory process
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Modalities of treatment
Conservative treatmentSurgical treatment
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Conservative treatment
Oxygen 5Ltr/Min Nil per oralFluid recitation NGT for decompression CatheterizationIV antibioticsAnalgesia Steroids
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Surgical treatment
Pre-op preparationIntra-op management Post-op management
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Intra op management
Surgical incisionCorrect the source of infectionPeritoneal lavageFix the drainage Close the abdomen
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Post op care
IV fluidsNGTAntibioticsAnalgesia Monitoring
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COMLICATION
Systemic complications abdominal Complication
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Systemic complications
SepticemiaSeptic shockRenal failureElectrolyte imbalanceMulti-organ failureRespiratory infection DIC DVT
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Abdominal Complication
Abdominal-pelvic abscessAdhesions Paralytic ileus Tertiary peritonitis Liver abscess
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PROGNOSIS
Depends on the following factors-age -sex-peritoneal score system
APACHE II scoreSimplified physiology ScoreSepsis severity scoreMannheim peritonitis score
-development of tertiary peritonitis
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References
Bailey & love 25th Edwww.medscape.com SRB manual of sugery 3rd edition by Spiram
Bhat MTertiary peritonitis
www.ncbi.nlm.nih.gov/pubmed/9451931
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Asanten kwa usikivu