Peritonitis-dinakaran soundara paulraj,group 18.ppt

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1. HELLO!
My topic s
Peritonitis
Name :dinakaran soundara
paulraj
Group :18
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2. Anatomy and Physiology
▹ The peritoneum is a thing, double layer of
serous membrane in the abdominal cavity
▹ The area of the peritoneum is around
2 square meters
▹ Peritoneum tissue is a typical connective
tissue, is covered by polygonal mesothelium
▹ has very good plastic peculiarities;
▹ has a very good blood supply

3. ”

4. Dorsal mesentery
Mesentery proper Small intestine (jejunum and
ileum) Posterior abdominal wall Superior mesenteric
artery, accompanying veins, autonomic nerve
plexuses, lymphatics, 100–200 lymph nodes and
connective tissue with fat
Transverse mesocolon Transverse colon Posterior
abdominal wall Middle colic
Sigmoid mesocolon Sigmoid colon Pelvic wall Sigmoid
arteries
 and superior rectal artery
Mesoappendix Mesentery of ileum Appendix
Appendicular artery

5. Anatomy and Physiology
All organs are divided on 3 groups:
1)Intraperitoneal
2)Mesoperitoneal
3)Extraperitoneal

6. Anatomy and Physiology
▹ The parietal peritoneum is innervated by the sensitive
somatic nerves
▹ The pain as a result of the parietal peritoneum
irritation is localized (somatic pain)
▹ The pelvic peritoneum has no somatic innervations
▹ The visceral peritoneum has vegetative
(parasympathic and sympathic) innervations
▹ The pain as a result of the visceral peritoneum
irritation is not localized

7. Definition
Peritonitis is an inflammation of the peritoneum
may be localized or generalised.

8. Classification

A.Acute
peritonitis
B.Subacute
peritonitis
C.Chronic
peritonitis
1.Primary
peritonitis
2.Secondary
peritonitis
3.Tertiary
peritonitis
4.Meconium
peritonitis
1.Serous peritonitis
2. Fibrinous
peritonitis
3. Fibrinopurulent
peritonitis
4. Purulent
peritonitis
5. Hemorrhagic
peritonitis

9. Classification
I Bacterial peritonitis
a) staphylococcus
b) streptococcus
c) proteus
d) enterococcus
II Sterile peritonitis
a) caused by bile
b) caused by
pancreatic enzymes
I.Local peritonitis
a) encapsulated
(abscess)
b) non-encapsulated
II. General peritonitis
a) Diffuse
b) Total

10. Clinical Classification
Stages of Peritonitis
1.Initial (reactive) stage (up
to 24 hours)
2.Toxic stage (24- 72 hours)
3.Terminal stage (after 72
hours)

11. ETIOLOGY
▹Bacterial, gastrointestinal and non-gastrointestinal
▹Chemical, e.g. bile, barium
▹Allergic, e.g. starch peritonitis
▹Traumatic, e.g. operative handling
▹ Ischaemia, e.g. strangulated bowel, vascular
occlusion
▹ Miscellaneous, e.g. familial Mediterranean fever

12. Paths to peritoneal infection
▹Gastrointestinal perforation, e.g. perforated ulcer,
appendix, diverticulum
▹Transmural translocation (no perforation), e.g.
pancreatitis, ischaemic bowel
▹Exogenous contamination, e.g. drains, open surgery,
trauma
▹ Female genital tract infection, e.g. pelvic inflammatory
disease
▹ Haematogenous spread (rare), e.g. septicaemia

13. Clinical features
▹Abdominal pain
▹Tenderness to palpation
▹Increased abdominal wall rigidity
▹Anorexia and nausea
▹Vomiting
▹Fever
▹Tachycardia

14. Diagnosis
Bedside
▹Urine dipstix for urinary tract infection
▹ECG if diagnostic doubt (as to cause of abdominal pain) or cardiac history.
Bloods
▹Baseline U&E for treatment
▹ Full blood count for white cell count (WCC)
▹ Serum amylase estimation may establish the diagnosis of acute pancreatitis
Imaging
▹Erect chest radiograph to demonstrate free subdiaphramatic gas
▹A supine radiograph of the abdomen may confirm the presence of dilated gas-
filled loops of bowel (consistent with a paralytic ileus),
▹the faecal pattern may act as a guide to colonic disease (absent in sites of
significant inflammation, e.g. diverticulitis
▹Multiplanar computed tomography (CT)

15. Lab Analyses
▹Leukocytosis or leukocytopenia
▹Dehydration and acidosis
▹Peritoneal fluid analysis

16. Treatment
▹Management of peritonitis
Operative treatment of cause when appropriate
▹Remove or divert cause
▹Peritoneal lavage ± drainage
General care of patient
▹Correction of fluid and electrolyte imbalance
▹Insertion of nasogastric drainage tube and urinary catheter
▹Broad-spectrum antibiotic therapy
▹ Analgesia
▹Vital system support

17. Complications of peritonitis
▹Systemic complications
▹Bacteraemic/endotoxic shock
▹Systemic inflammatory response syndrome
▹Multiorgan dysfunction syndrome
▹Death
Abdominal complications
▹Paralytic ileus
▹Residual or recurrent abscess/inflammatory mass
▹Portal pyaemia/liver abscess
▹Adhesional small bowel obstruction

18. Reference:
▹Bailey And Love's Short Practice of Surgery 26th Edpage
970
▹https://en.wikipedia.org/wiki/Peritonitis
▹Genuit T and Napolitano L. 2004. Peritonitis and
Abdominal Sepsis at Emedicine.com
▹openabdomen.org - Peritonitis,galal Medical and
Surgical Therapy Reviewed
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19. THANKS!
Any questions?
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