eMentorSurgery

 Dear students, This is only for your revision and NOT A FULL TEXT. 

Peritonitis

Definitionof Peritoneum

•        Peritoneum:

•        The membrane that lines the abdominal cavityand covers most of the abdominal organs.

•        (From the Greek peri- meaning around + tonosmeaning a stretching = a stretching around).

 •        Peritoneum

– serous membrane of the abdominal cavity

–       Visceral – covers external surface of mostdigestive organs

–       Parietal – lines the body wall

•        Peritoneal cavity

–       Lubricates digestive organs

–       Allows them to slide across one another.

•        Peritoneum and PeritonealCavity 

•        Mesentery – double layer of peritoneum

Mesentery

–       Vascular and nerve supplies to the viscera

–       A means to hold digestive organs in place andstore fat

•        Retroperitoneal organs – organs outside the peritoneum

•        Intraperitoneal – organs surrounded by peritoneum

Peritonitis

Peritonitis is the inflammation of Peritonium, most oftenby Bacteria.

Bacteria :        Esch. Coli

            Aerobic&       Anaerobic       Streptococci

            Bacteroids and others

Types Of Peritonitis

Acute

            Bacterial

                        Primary

                        Secondary  

            Chemical

Chronic

 Routes of Infection

G.I. Perforation

From Outside Injuries, drains

Transmural I.B. Disease, Gangrene

Female Genital Tract

Haematogenous

 Pathology

Whole Peritonial surface inflamed

Congested , Oedematous

Covered with Fibrin flakes

Inflammatory Exudate

Adhesions will form

Paralytic Ileus sets in

 Factors which favour localisation of Peritonitis

Anatomical

Pathological ( Adhesions, Ileus)

Omentum

Factors which favour Spread of Peritonitis

Speed of contamination

Peristalisis  (Purgatives,Enema)

Virulence of Organism

Age (extremes)

 Common Causes of Peritonitis

            D.UPerforation

            Appendicitis

            TyphoidPerforation

            Cholecystitis

            Trauma (Bowel Perforation)

            SepticInduced Abortion

            AnastamoticLeak

            Diverticulitis

            CarcinomaColonPerforation

Symptoms

            Pain

            Vomiting

            Fever

            AbdominalDistension

Signs

            Tachycardia

            Tachypnoea

            Hypotension

            Fever 

            Distension     

            Tenderness

            Guarding  & Rigidity

            DecreasedMovement          

            ReboundTenderness

            FreeFluid

            Pneumoperitonium

            AbsentBowel Sounds

            Tendernesson P/R

Late Signs      Sunken eyes

            ColdClammy extremities

            DryTongue

            Rapidthready Pulse

            AnxiousFace

Differential Diagnosis

            IntestinalObstruction

            AcutePancreatitis

            ParalyticIleus

Investigations

Leucocytosis

X – Ray Abdomen  ( Erect )

            Pneumoperitonium

            Groundglass apaaearence

            Obliteratedfat lines

Paracentesis  (4Quadrant )

Ultrasound Abdomen

            FluidCollections

C.T. Scan

            Abscesses,  Fluid collections

Isotope Scan

Treatment

General

            Hospitalise

            N.P.O.             Ryle’s  Tube Asp.

            I.V.Fluids

            BloodTransfusion

            Antibiotics

            Input –Output

            Charts

Support Organ systems

            Renal

            Respiratory,    Circulatory

Treatment

Specific

            PeritonialLavage

            Drains

Continue Post Operative Treat.

Treatment

Non - Operative treatment

            Indications

                        TooSick Patient

                        SealedPerforation

                        LocalisedPeritonitis(minimall)

Prognosis

            UsualyGood

                        IF

 treated

                        PROMPTLY  !

Complications

Paralytic Ileus

Residual Abscess

Intestinal Obstruction Adhesions

Septicaemia & Organ Failure

            Renal,  Respiratory

            EndotoxicShock

Localised Peritonitis

Peritonitis Confined

Localised Tenderness

Localised Guarding

Acute Appendicitis

            Cholecystitis

Localised Peritonitis-Treatment

Usually Conservative

May form Residual Abscesses

Ultrasound Guided Aspiration

C. T. Guided Aspiration

Special Types of Peritonitis

Bile Peritonitis

            Cholecystitis,Perforation

            Injuriesto CBD

            Leakfrom Biliary Anasatamosis

Pnemococcal Peritonitis

Primary   Or    Secondary

            Girls   3 – 6 Yrs.

            GenitalTract Is The Source

            LowerAbdominal Pain

            Fever& Vomiting

            D.D. Ac.Appendicitis

Laparotomy

Primary Streptococcal Peritonitis

Streptococcus

Thin Watery Pus

Presentation Similar to Pneumococcal Peritonitis

Laparotomy

Antibiotics

Idiopathic Streptococcal and Staphylococcal Peritonitis

Rare But High Mortality

Staphylococcal Peritonitis

            IntravaginalTampons

            ToxicShock Syndrome

            D. I.C.

Tuberculous Peritonitis

Acute

Chronic

Acute Mimics Acute Peritonitis

            Ascitiswith Tubercles

            Biopsyof Omentum

            Antituberculoustreatment

Chronic Tuberculous Peritonitis

            Abd.Pain                                90 %

            Fever                                      60%

            Wt. Loss                                 60%

            Ascitis                                     60%

            NightSweats              37%

            Abd.Mass                              26%

Chronic Tuberculous Peritonitis

            Types   Ascitic Form

                                    EncystedForm

                                    FibrousForm

                                    PurulentForm

Chronic Tuberculous Peritonitis

Pathology

            PeritoniumStudded with        Tubercles

            Ascitisstraw Coloured Fluid

            LymphNodes Enlarged

            Adhesionsmight form

Chronic Tuberculous Peritonitis

Clinical Features

            Insidiousonset

            Loss ofWeight  &  Appettite

            Fever

            Abdominaldistension

            Diarrhoea

Chronic Tuberculous Peritonitis

Clinical Features

            RolledUp Omentum

Laparoscopy or Laparotomy

Biopsy of Omentum

Antituberculous Treatment

Chronic Tuberculous Peritonitis

Encysted Form

            LocalisedAscitic Collection

            D. D.Mesenteric Cyst

                                    OvarianCyst

Fibrous Form

Adhesions  -  Intestinal Obstruction

Chronic Tuberculous Peritonitis

Purulent Form

            CaseousPus

            BetweenCoils of Intestines

            InPelvis