sfuchas MD5 PPT

1. PERITONITIS

2. Name of participants
1.SULLY SIMKOKO
2.ROCHIUS MODEST
3.ALEX LIPENDELE
4.PHILIP JOHN
5.ALPHA KWILASA

3. Outline
• Introduction
• Etiology
• Classification
• Pathophysiology
• Clinical presentation
• Work up
• Management
• Complication
• Prognosis
• References

4. INTRODUCTION
• Peritonitis is the inflammation of the
peritoneum
• The peritoneum is the serous membrane
which encloses the abdominal cavity and its
contents
Parietal peritoneum
Visceral peritoneum

5. Etiology
• Infectious
Bacteria eg. E. coli, streptococcus (aerobes &
anaerobes), etc
Non bacteria eg. Fungal and virus
• Non infectious
Chemical peritonitis eg. gastric acid, bile and
blood

6. CLASSIFICATION
• Anatomical
• Etiological
• Pathological
• Clinical

7. Anatomical classification
 Localized peritonitis
Factors which favor localized peritonitis
-compartmentalization of abdominal cavity
-pathological factor
-surgical factor
 Diffused/generalized peritonitis
Factors
-sudden visceral perforation
-vigorous peristalsis
-immune compromised pt
-age(infants)
-poor handling of localized infection

8. Etiological classification
Infectious peritonitis
-bacterial
-non bacterial
Non infectious(chemical) peritonitis

9. Pathological classification
Primary peritonitis
-due to spontaneous bacterial invasion of
peritoneum
Secondary 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

10. Clinical peritonitis
Acute peritonitis
-this is of sudden onset
eg bacterial peritonitis
Chronic peritonitis
-present with gradual onset
eg TB peritonitis

11. PATHOPHYSIOLOGY
Absorption of irritant
Stimulation/activation of immune system
Localization of infection by host defense

12. Clinical stages of peritonitis
 Peritonism/irritation
 Reaction
 Diffuse peritonitis

13. CLINICAL PRESENTATION
 History
 Physical examination

14. History/symptoms
Abdominal pain
Anorexia
Nausea and vomiting
Fever
Constipation

15. Physical examination
General examination
Systemic examination

16. General examination
Shallow breathing
Dehydration
Tachycardia
Tachypnoic
Febrile above 38 degree of centigrade
 Hypotension
 Toxic with ‘facies Hippocratic’
 Features of septic shock

17. facies Hippocratic

18. 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

19. WORKUP
 Laboratory studies
 Imaging studies
 Diagnostic procedures

20. Laboratory studies
FBP and ESR
Serum electrolyte
Serum createnin and blood urea
Serum amylase
C-reactive protein
Blood grouping and X-match
Blood gases

21. Imaging studies
 Plain thoraco-abdominal X-ray (erect)
 Abdominal USS
 Abdominal CT Scan
 MRI

22. Diagnostic procedures
Peritoneal fluid aspiration
-For gram stain, culture and sensitivity
Laparoscopic investigation

23. MANAGEMENT
• Principles of treatment
• Modalities of treatment

24. Principles of treatment
Control of source of infection
Elimination of bacteria and toxins
Maintain organ system functioning
To control inflammatory process

25. Modalities of treatment
Conservative treatment
Surgical treatment

26. Conservative treatment
Oxygen 5Ltr/Min
Nil per oral
Fluid recitation
NGT for decompression
 Catheterization
IV antibiotics
Analgesia
Steroids

27. Surgical treatment
Pre-op preparation
Intra-op management
Post-op management

28. Intra op management
Surgical incision
Correct the source of infection
Peritoneal lavage
Fix the drainage
Close the abdomen

29. Post op care
IV fluids
NGT
Antibiotics
Analgesia
Monitoring

30. COMLICATION
Systemic complications
 abdominal Complication

31. Systemic complications
Septicemia
Septic shock
Renal failure
Electrolyte imbalance
Multi-organ failure
Respiratory infection
DIC
DVT

32. Abdominal Complication
Abdominal-pelvic abscess
Adhesions
Paralytic ileus
Tertiary peritonitis
Liver abscess

33. PROGNOSIS
Depends on the following factors
-age
-sex
-peritoneal score system
APACHE II score
Simplified physiology Score
Sepsis severity score
Mannheim peritonitis score
-development of tertiary peritonitis

34. References
Bailey & love 25th Ed
www.medscape.com
SRB manual of sugery 3rd edition by Spiram
Bhat M
Tertiary peritonitis
www.ncbi.nlm.nih.gov/pubmed/9451931