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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
- 6. Paths to peritonitis GI perforation Transmural translocation ( bacterial translocation) Exogenous contamination Female GUT infection
- 7. Microbiology Gram negative bacteria Clostridium perfringens chlamydia spp
- 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.
- 10. IMAGING XRAY CT ULTRASOUND
- 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
- 15. Reference Bailey and love short practice of surgery 27th edition Pg : 1048 – 1052
- 16. THANK YOU ………… Questions are warmly welcomed
Editor's Notes
- 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 -