Acute suppurative peritonitis is an inflammatory or infectious response of the peritoneal lining caused by direct irritation or contamination. Common causes include perforations of the large bowel, ischemic small bowel injuries, and acute necrotizing pancreatitis. Clinically, patients present with abdominal pain and tenderness as well as systemic symptoms like fever, chills, and hypotension. Diagnosis is aided by imaging like ultrasound, CT scan, and plain films. Treatment involves preoperative care with IV fluids and antibiotics as well as source control through surgery to remove infected material, correct the underlying cause, and prevent complications.

1. Acute Suppurative Peritonitis Lu Ning, PhD, MD General Surgery Department Tianjin University Hospital

2. THE PERITONEUM & ITS FUNCTIONS Lubrication and protection--- Intraperitoneal circulation Nearly 1 m 2 of the total 1.7 m 2 area participates in fluid exchange with the extracellular fluid Rate: 500 mL or more per hour. Normally, there is less than 50 mL of free peritoneal fluid: From other sites towards subdiaphragmatic regions bilaterally

3. THE PERITONEUM & ITS FUNCTIONS Characteristics of peritoneal transudate: specific gravity below 1.016 protein concentration less than 3 g/dL white blood cell count less than 3000/uL complement-mediated antibacterial activity lack of fibrinogen-related clot formation.

4. PERITONITIS Definition--- an inflammatory or suppurative response of the peritoneal lining to direct irritation. Inflammatory response of peritoneaum increased blood flow increased permeability formation of a fibrinous exudate on its surface

5. PERITONITIS Primary or spontaneous peritonitis can occur as a diffuse bacterial infection without an obvious intra-abdominal source of contamination. Secondary peritonitis results from bacterial contamination originating from within viscera or from external sources (eg, penetrating injury).

6. Causations of Peritonitis

7. Common causes of peritonitis. 20-80% Large bowel perforations Ischemic small bowel injuries Acute necrotizing pancreatitis Postoperative complications Severe <20% Diverticulitis (localized perforations) Nonvascular small bowel perforation Gangrenous cholecystitis Multiple trauma Moderate <10% Appendicitis Perforated gastroduodenal ulcers Acute salpingitis Mild Mortality Rate Cause Severity

8. Clinical Findings ---pain

9. Clinical Findings-- Local findings Signs that reflect parietal peritoneal irritation and resulting ileus Peritonitis sign Tenderness Rebound tenderness Guarding or rigidity Distention Free peritoneal air Diminished bowel sounds

10. Clinical Findings -- Systemic findings Fever, chills or rigors, tachycardia, sweating, tachypnea, restlessness, dehydration, oliguria, disorientation, and, ultimately, refractory shock.

11. Diagnostic Imagine B-us Abdominal Plain film CT scan

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16. Treatment --- Preoperative Care 1. Intravenous 2. Care for advanced 3. Antibiotics

17. Treatment --- Operative Managenment Objectives of surgery for peritonitis Complete Debridment:remove all infected material Correct the underlying cause Prevent late complications.

18. Treatment --- Operative Managenment Control of sepsis Peritoneal lavage Peritoneal drainage Management of abdominal distention

19. Complications Deep wound infections Residual abscesses Intraperitoneal sepsis Anastomotic breakdown Fistula formation