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PERITONITIS
BY DR ANKUSH AGARWAL
1ST YEAR RESIDENT
DEPT OF GENERAL MEDICINE
DEFINITION
 AN INFLAMATORY OR SUPPARATIVE REACTION OF THE PERITONEAL LINING TO
AN IRRITANT
 ANY PATHALOGY ALTERING THE QUANTITY OR QUALITY OF PERITONEAL FLUID
CAN RESULT IN PERITONITIS.
 THE IRRITANT CAUSES THE FOLLOWING CHANGES IN THE PERITONEAL LINING;
 INCREASED BLOOD FLOW
 INCREASED PERMEABILITY
 FORMATION OF FIBROUS EXUDATED ON THE PERITONEAL SURFACE
CAUSES OF PERITONITIS
 BACTERIAL INFECTIONS
 GI RELATED- SPONTANEOUS/ TRANSMURAL TRANSLOCATION OF BACTERIA,
PERFORATION OF BOWEL, PANCREATITIS
 NON- GI RELATED- PID, TORSION OF OVARY, PERITONEAL DIALYSIS, PERFORATING
INJURY TO ABDOMEN.
 CHEMICAL
 ALLERGIC
 TRAUMATIC
 ISCHAEMIA
FUNCTIONS OF PERITONEUM
 LUBRICATION
 ABSORPTION AND EXUDATION
 PAIN PERCEPTION;
 PARIETAL PERITONEUM IS MORE PAIN SENSITIVE AND IS LOCALISED
 VISCERAL PERITONEUM IS LESS SENSITIVE AND POORLY LOCALISED
 INFLAMMATORY AND IMMUNE RESPONSES
 FIBRINOLYTIC ACTIVITY
PERITONITIS
NON SURGICAL/
PRIMARY
SURGICAL/
SECONDARY
SURGICAL CAUSES AND SEVERITY OF
PERITONITIS
ASCITIC FLUID INFECTION
 SEEN IN PATIENTS WITH DCLD WITH ASCITIS
 CAUSED DUE TO OVERGROWTH OF SPECIFIC ORGANISM IN THE
INTESTINE AND THEN TRANSLOCATION OF THAT MICROBE TO
MESENTRIC LYMPH NODE.
 SUBTYPES OF SPONTANEOUS ASCITIC FLUID INFECTION
 SPONTANEOUS BACTERIAL PERITONITIS- CULTURE POSITIVE WITH
PMN GREATER THAN OR EQUAL TO 250/CUBIC MM.
 MONOMICROBIAL NON- NEUTROCYTIC BACTERASCITIS (MNB)-
POSITIVE ASCITIC FLUID CULTURE FOR SINGLE ORGANISM, AN
ASCITIC FLUID PMN COUNT LESSER THAN 250/CUBIC MM
 CULTURE NEGATIVE NEUTROCYTIC ASCITIS (CNNA)- NEGATIVE
ASCITIC FLUID CULTURE REPORT, PMN COUNT GREATER THAN OR
EQUAL TO 250/CUBIC MM, NO ANTIBIOTICS GIVEN, NO OTHER
EXPLANATION FOR INCREASED PMN (HEMORRHAGE INTO ASCITIS,
PERITONEAL CARCINOMATOSIS, TB, OR PANCREATITIS
 SURGICAL/ SECONDARY BACTERIAL PERITONITIC- CULTURE
POSITIVE USUALLY FOR MULTIPLE ORGANISM, PMN GREATER THAN
OR EQUAL TO 250/ CUBIC MM, INTRAABDOMINAL SURGICALLY
TREATABLE CAUSE OF INFECTION
 POLYMICROBIAL BACTERASCITIS- MULTIPLE ORGANISM ON CULTURE.
DIFFERENTIATING BETWEEN SBP AND
SECONDARY BACTERIAL PERITONITIS
BACTERIOLOGY
RISK FACTORS FOR SBP
 PATIENT WITH CIRRHOSIS DUE TO MULTIPLE DEFECTS IN IMMUNE DEFENSES
 LOW ASCITIC FLUID TOTAL PROTEIN CONCENTRATION
 PHAGOCYTIC DYSFUNCTION
 THEORITICALLY- PARACENTESIS
 GI HEMORRHAGE
 UTI
SYMPTOMS AND SIGNS
DIAGNOSIS
TREATMENT
PREVENTION OF SBP

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Peritonitis

  • 1. PERITONITIS BY DR ANKUSH AGARWAL 1ST YEAR RESIDENT DEPT OF GENERAL MEDICINE
  • 2. DEFINITION  AN INFLAMATORY OR SUPPARATIVE REACTION OF THE PERITONEAL LINING TO AN IRRITANT  ANY PATHALOGY ALTERING THE QUANTITY OR QUALITY OF PERITONEAL FLUID CAN RESULT IN PERITONITIS.  THE IRRITANT CAUSES THE FOLLOWING CHANGES IN THE PERITONEAL LINING;  INCREASED BLOOD FLOW  INCREASED PERMEABILITY  FORMATION OF FIBROUS EXUDATED ON THE PERITONEAL SURFACE
  • 3. CAUSES OF PERITONITIS  BACTERIAL INFECTIONS  GI RELATED- SPONTANEOUS/ TRANSMURAL TRANSLOCATION OF BACTERIA, PERFORATION OF BOWEL, PANCREATITIS  NON- GI RELATED- PID, TORSION OF OVARY, PERITONEAL DIALYSIS, PERFORATING INJURY TO ABDOMEN.  CHEMICAL  ALLERGIC  TRAUMATIC  ISCHAEMIA
  • 4. FUNCTIONS OF PERITONEUM  LUBRICATION  ABSORPTION AND EXUDATION  PAIN PERCEPTION;  PARIETAL PERITONEUM IS MORE PAIN SENSITIVE AND IS LOCALISED  VISCERAL PERITONEUM IS LESS SENSITIVE AND POORLY LOCALISED  INFLAMMATORY AND IMMUNE RESPONSES  FIBRINOLYTIC ACTIVITY
  • 6. SURGICAL CAUSES AND SEVERITY OF PERITONITIS
  • 7. ASCITIC FLUID INFECTION  SEEN IN PATIENTS WITH DCLD WITH ASCITIS  CAUSED DUE TO OVERGROWTH OF SPECIFIC ORGANISM IN THE INTESTINE AND THEN TRANSLOCATION OF THAT MICROBE TO MESENTRIC LYMPH NODE.
  • 8.  SUBTYPES OF SPONTANEOUS ASCITIC FLUID INFECTION  SPONTANEOUS BACTERIAL PERITONITIS- CULTURE POSITIVE WITH PMN GREATER THAN OR EQUAL TO 250/CUBIC MM.  MONOMICROBIAL NON- NEUTROCYTIC BACTERASCITIS (MNB)- POSITIVE ASCITIC FLUID CULTURE FOR SINGLE ORGANISM, AN ASCITIC FLUID PMN COUNT LESSER THAN 250/CUBIC MM  CULTURE NEGATIVE NEUTROCYTIC ASCITIS (CNNA)- NEGATIVE ASCITIC FLUID CULTURE REPORT, PMN COUNT GREATER THAN OR EQUAL TO 250/CUBIC MM, NO ANTIBIOTICS GIVEN, NO OTHER EXPLANATION FOR INCREASED PMN (HEMORRHAGE INTO ASCITIS, PERITONEAL CARCINOMATOSIS, TB, OR PANCREATITIS  SURGICAL/ SECONDARY BACTERIAL PERITONITIC- CULTURE POSITIVE USUALLY FOR MULTIPLE ORGANISM, PMN GREATER THAN OR EQUAL TO 250/ CUBIC MM, INTRAABDOMINAL SURGICALLY TREATABLE CAUSE OF INFECTION  POLYMICROBIAL BACTERASCITIS- MULTIPLE ORGANISM ON CULTURE.
  • 9. DIFFERENTIATING BETWEEN SBP AND SECONDARY BACTERIAL PERITONITIS
  • 11. RISK FACTORS FOR SBP  PATIENT WITH CIRRHOSIS DUE TO MULTIPLE DEFECTS IN IMMUNE DEFENSES  LOW ASCITIC FLUID TOTAL PROTEIN CONCENTRATION  PHAGOCYTIC DYSFUNCTION  THEORITICALLY- PARACENTESIS  GI HEMORRHAGE  UTI