PERITONITIS.pptx

Diagnosis of peritonitis

1. PERITONITIS PRESENTER: DR M B PHIRI MODERATOR: DR MUKUNYANDELA

2. OUTLINE Definition Anatomy Classification Pathogenesis Signs and symptoms Investigation Management

3. defination Inflamation of the peritoneum (serosa)

4. anatomy Peritonuem is a serous membrane that has 2 layers parietal and visceral Potential space between the 2 layers Normally peritoneal fluid is less than 50ml (ultrafiltrate)

5. classification ACUTE PERITONITIS Primary (spontaneous) Secondary – acute suppurative, granulomatous, chemical (aseptic), interventional, traumatic, drug induced CHRONIC PERITONITIS Infectious, drug induced, chemical, foreign body, carcinomatous

6. Primary peritonitis Also called spontaneous peritonitis No obvious identifiable cause Common in girls and young women, infection presumed through fallopian tube Also common in adults with ascites as SBP and patients with indwelling catheter for peritoneal dialysis

7. SECONDARY PERITONITIS Acute suppurative Secondary to any bowel or other visceral pathology eg perforation of a viscus or extension of existing infection of an abdominal organ eg appendicular abscess, liver abscess Chemical (aseptic) peritonitis Peritoneal inflammation from other substances other than bacteria Perforated peptic ulcer provides chemical peritonitis and acute pancreatitis

8. PATHOGENESIS Initially localized, affected area contained by omentum Localized peritonitis may progress Exudation of inflammatory fluid into peritoneal cavity Diffuse peritoneal irritation causes peristaltic paralysis

9. cLINICAL MANIFESTATION Malaise, nausea, vomiting, low grade fever, abdominal pain Examination – tenderness, guarding or rigidity, distension, free peritoneal air, diminished bowel sounds Systemic findings – fever, chills, tarchycardia , restlessness, signs of shock APACHE II (Acute Physiology And Chronic Health Evaluation) uses 12 physiological variables and Mannheim peritonitis index uses 8 parameters

10. INVESTIGATIONS FBC, ABGs, electrolytes, LFT, RFT Radiology – abdominal xray , abd U/S Paracentesis Laparascopy

11. MANAGEMENT Principles To control source of infection To eliminate micro organisms To maintain vital organ function Nutrition and metabolic support Mordalities of therapy Fluid rescussitation Systemic antibiotics Surgical drainage

12. REFERENCES Bailey and love SRB manual