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Peritonitis
1. PERITONITIS
By Mohammed Shadabul Haqh
16901087
Contact : 056-176-4224
Email : mohammed.16901087@rakmhsu.ac.ae
2. Map of the presentation
Case study
Paths to peritonitis
Microbiology of peritonitis
Clinical features
Investigations
Imaging
Management
Special forms of peritonitis
References
3. A 42 year-old male presented to Hospital for evaluation of worsening
abdominal pain, nausea and vomiting starting 3 days prior to
presentation. On admission, his history was remarkable for four similar
prior episodes over the previous five years that lasted between 3 and 5
days. He denied any constipation, obstipation or associated
hematemesis, fevers, chills or urinary symptoms. During the first
episode five years ago, he was evaluated at an outlying health center
and diagnosed with peptic ulcer disease and was managed with
omeprazole intermittently . His past medical and surgical history was
non contributory and he had no allergies and he denied alcohol intake
or tobacco use. His HIV serostatus was negative approximately one year
prior to presentation.
CASE
4. On examination he was afebrile, with a heart rate of 120
beats/min, blood pressure 135/78 mmHg and respiratory
rate of 22/min. Abdominal examination revealed mild
distension with generalized guarding and marked rebound
tenderness in the epigastrium. There were no palpable
masses and bowel sounds were absent. Full blood count
and serum chemistry was unavailable . Erect and supine
abdominal and chest radiographs were normal however,
abdominal ultrasonography revealed free fluid throughout
the abdomen and pelvis
5.
6. Paths to peritonitis
GI perforation
Transmural translocation ( bacterial translocation)
Exogenous contamination
Female GUT infection
8. Clinical features
Abdominal pain – worse on movement, coughing, deep inspiration
Constitutional upset (AMF)
GI upset
Raised pulse rate
Tenderness = guarding, rigidity, rebound
Rectal or vaginal tenderness ( pelvic peritonitis)
Absent bowel sounds
SIRS and MODS (later stages )
9. INVESTIGATIONS
Baseline urea and electrolytes (U&Es) for treatment.
Full blood count for white cell count (WCC).
Serum amylase
Urine dipstix for urinary tract infection.
13. MANAGEMENT
General care of the patient
Specific treatment of the cause
ANTIBIOTICS
ANALGESIA
CORRECTION OF FLUID LOSS AND CIRCULATING VOLUME
14. SPECIAL FORMS OF PERITONITIS
Bile peritonitis
Spontaneous bacterial
Primary pneumococcal peritonitis
TB peritonitis
Peritonitis is simply defines as inflammation of the peritoneum and maybe localized or generalized.
Peritonitis Is used without qualification acute bacterial peritonitis
Gi – perforated ulcer, appendix, diverticulum
Transmural translocation – no perforation … pancreatitis , ischemic bowel
Ex contamination -