sindromul peritoneal

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 1/38

 

SINDROMUL

PERITONEALProf. Nursing

 Asist.Med.Mrd.Ec Cristina Chiriac

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 2/38

 

Peritoneul

►Mezoteliul ce căptuşeşte cavitateaperitoneală şi conţinutul acesteia 

►Derivă din celomul primitiv (mezoderm) 

►Suprafaţă totală la adult 2 m²

►Membrană de transfer pasiv 

►Sistem imun de apărare propriu 

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 3/38

 

 Aspect laparoscopic

http://rds.yahoo.com/_ylt=A9iby4DjcFBGiRAASkGJzbkF;_ylu=X3oDMTBwMzZzcjU3BHBvcwM2BHNlYwNzcgR2dGlkA0kwNjZfODg-/SIG=1hsdp635q/EXP=1179763299/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dperitoneum%2526ei%253DUTF-8%2526fr%253Dslv8-msgr%2526x%253Dwrt%26w=207%26h=154%26imgurl=www.vision.ee.ethz.ch%252Fprojects%252FLasso%252Fgraphical%252Fvess%252Fimages%252Fperitoneum.gif%26rurl=http%253A%252F%252Fwww.vision.ee.ethz.ch%252Fprojects%252FLasso%252Fgraphical%252Fvess%252Fvess%252Fvess_frame.html%26size=27.8kB%26name=peritoneum.gif%26p=peritoneum%26type=gif%26no=6%26tt=672%26oid=da1f85e6f03f653c%26ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 4/38

 

Peritonite:DEFINIŢIE 

►Inflamaţia peritoneului localizată saugeneralizată secundară: 

►Exsudaţiei  – fenomene de tip inflamatorseptic sau aseptic

- proliferative

►

Traumatice►Blocaj limfatic

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 5/38

 

 Aspect laparoscopic

http://rds.yahoo.com/_ylt=A9iby4DjcFBGiRAASkGJzbkF;_ylu=X3oDMTBwMzZzcjU3BHBvcwM2BHNlYwNzcgR2dGlkA0kwNjZfODg-/SIG=1hsdp635q/EXP=1179763299/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dperitoneum%2526ei%253DUTF-8%2526fr%253Dslv8-msgr%2526x%253Dwrt%26w=207%26h=154%26imgurl=www.vision.ee.ethz.ch%252Fprojects%252FLasso%252Fgraphical%252Fvess%252Fimages%252Fperitoneum.gif%26rurl=http%253A%252F%252Fwww.vision.ee.ethz.ch%252Fprojects%252FLasso%252Fgraphical%252Fvess%252Fvess%252Fvess_frame.html%26size=27.8kB%26name=peritoneum.gif%26p=peritoneum%26type=gif%26no=6%26tt=672%26oid=da1f85e6f03f653c%26ei=UTF-8
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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 6/38

 

Clasificare

Primare – infecţia primară a unei ascite fărăo sursă evidentă 

Secundare – de la o sursă definită prinleziuni ale organelor acoperite de peritoneu

Forme particulare:

► Acută supurată 

►Granulomatoasă 

►Chimică aseptică 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 7/38

Germeni

Gram negativi marea majoritate

►E. coli

►K. pneumoniae

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 8/38

Cauze frecvente

►Ulcer perforat

► Apendicită acută 

►Diverticulită ►SEU

►Cancere perforate

►Traumatice►Intervenţionale sau chirurgicale 

 

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http://rds.yahoo.com/_ylt=A9iby4c_cVBG21AAtkKJzbkF;_ylu=X3oDMTBxcWRybXI1BHBvcwM1NQRzZWMDc3IEdnRpZANJMDY2Xzg4/SIG=1ia7b16n3/EXP=1179763391/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dperitoneum%2526ei%253DUTF-8%2526fr%253Dslv8-msgr%2526b%253D41%26w=1280%26h=954%26imgurl=bmj.bmjjournals.com%252Fcontent%252Fvol323%252Fissue7304%252Fimages%252Flarge%252Fprea1117.f1.jpeg%26rurl=http%253A%252F%252Fwww.gfmer.ch%252Fselected_images_v2%252Fdetail_list.php%253Fcat1%253D18%2526cat3%253D143%2526stype%253Dd%26size=236.7kB%26name=prea1117.f1.jpeg%26p=peritoneum%26type=jpeg%26no=55%26tt=672%26oid=50630192fdc1d324%26ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 9/38

Carcinomatoza

► 

 

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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 10/38

 Alte cauze

►TB

►Dializa peritoneală 

►

Imunodeprimaţi ►Chimică iatrogenă 

►Biliară 

►Urinară

 

http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 11/38

 Alte cauze

►Mezoteliom

►Pseudomixom

►

Carcinomatoze secundare

 

http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 12/38

Clinica

Durerea

►-punct de plecare

►-difuzare rapidă 

►-lovitură de cuţit 

►-intensă 

►-continuă 

►-tahipnee antalgică 

►-anteflexie

 

http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 13/38

Clinica

Poate fi estompată de antalgiceadministrate anterior!

 

http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D61&w=504&h=331&imgurl=www-medlib.med.utah.edu%2FWebPath%2Fjpeg4%2FGI222.jpg&rurl=http%3A%2F%2Fwww-medlib.med.utah.edu%2FWebPath%2FNEOHTML%2FNEOPL060.html&size=51.8kB&name=GI222.jpg&p=peritoneum&type=jpeg&no=69&tt=672&oid=40f7c669613cb23a&ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 14/38

Clinica

Simptome de asociere necaracteristice

►- greţuri 

►- vărsături 

►-oprirea tranzitului

►-febră 

►-frisoane

►-anorexie

►-semne de hipovolemie

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 15/38

Clinica Peritonitelor prin perforaţie 

►Examenul obiectiv determinant :

-  Absenţa zgomotelor hidroaerice 

-  Apărare şi contractura musculară(abdomenul de lemn)

- Dispariţia matităţii prehepatice 

- Durere acută la decomprimarea rapidă aabdomenului

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 16/38

 

► 

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 17/38

Peritonitelor primitive

 Ascita

►Matitate declivă 

►

Deplasabilă pe flancuri ►Semnul valului

►Semnul gheţarului 

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 18/38

 Variante

Peritonite închistate în:

►bursa omentală

►

 spaţiile parietocolice ► spaţiul Morisson 

►fundul de sac Douglas

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 19/38

Laborator

►Leucocitoză cu neutrofilie 

►

Deviere la stînga a formulei leucocitare► VSH accelerată 

►Fibrinogen

►RCP

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 20/38

Examenul lichidului-macroscopic

►Serocitrin

►Hemoragic

►

Purulent►Chilos

►Chiliform

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 21/38

Examenul lichidului-microscopic

Numărătoare elemente 

Tip elemente:

►

-hematii►-leucocite PMN

►-limfocite

►-maligne►-eozinofile

 

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http://rds.yahoo.com/_ylt=A9iby4EsdVBG7awAQjWJzbkF;_ylu=X3oDMTBwMzkxZHRrBHBvcwM0BHNlYwNzcgR2dGlkA0kwNjZfODg-/SIG=1fpqncrj9/EXP=1179764396/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dflat%252Babdomen%2526ei%253DUTF-8%2526fr%253Dslv8-msgr%2526x%253Dwrt%26w=234%26h=180%26imgurl=www.wingsofknowledge.com%252Fmy-ebook%252Fpics%252Fabdomen4.jpg%26rurl=http%253A%252F%252Fwww.wingsofknowledge.com%252Fmy-ebook%252Fabdomen.html%26size=15.8kB%26name=abdomen4.jpg%26p=flat%2Babdomen%26type=jpeg%26no=4%26tt=168%26oid=48b5b309aafd81c8%26ei=UTF-8

5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 22/38

Examenul lichidului-biochimic

►Rivalta

►

Determinăricantitative 

 de proteine, glucoză,amilaze, colesterol, trigliceride, pigmenţibiliari, LDH, etc

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 23/38

Examenul lichidului-cultura

►Medii uzuale

►Medii specifice

 Antibiograma

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 24/38

Radiologic

Pneumoperitoneu

►-imagine radiotransparentă în parteasuperioară a cavităţii peritoneale -subdiafragmatic

Examinare de preferat în ortostatism

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 25/38

 

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 26/38

 

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

http://slidepdf.com/reader/full/sindromul-peritoneal 27/38

 

 

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5/17/2018 Sindromul Peritoneal - slidepdf.com

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5/17/2018 Sindromul Peritoneal - slidepdf.com

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CT

 

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Ecografie

 

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Ecografie

 

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Laparoscopia

► 

 

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► 

 

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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D141&w=242&h=180&imgurl=www.multi-med.com%2Fpdigifs%2Fpdi20s3%2Fa122.JPG&rurl=http%3A%2F%2Fwww.multi-med.com%2Fpdigifs%2Fpdi20s3%2Ffigs%2F122.html&size=7.6kB&name=a122.JPG&p=peritoneum&type=jpeg&no=159&tt=672&oid=678b195c50b33c4e&ei=UTF-8
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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D141&w=242&h=180&imgurl=www.multi-med.com%2Fpdigifs%2Fpdi20s3%2Fa122.JPG&rurl=http%3A%2F%2Fwww.multi-med.com%2Fpdigifs%2Fpdi20s3%2Ffigs%2F122.html&size=7.6kB&name=a122.JPG&p=peritoneum&type=jpeg&no=159&tt=672&oid=678b195c50b33c4e&ei=UTF-8

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Laparotomia

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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D201&w=640&h=480&imgurl=www.openabdomen.org%2F7-PUB%2F436-jcbs%2FPics%2FMS%2520436%2520Jacobs%252003.jpg&rurl=http%3A%2F%2Fwww.openabdomen.org%2F7-PUB%2F436-jcbs%2F437txt.html&size=86.0kB&name=MS+436+Jacobs+03.jpg&p=peritoneum&type=jpeg&no=211&tt=672&oid=e2d8346f3c45ebf0&ei=UTF-8

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Diagnosticul

Clinic

Numai pentru confirmare şi paraclinic 

 

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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D201&w=640&h=480&imgurl=www.openabdomen.org%2F7-PUB%2F436-jcbs%2FPics%2FMS%2520436%2520Jacobs%252003.jpg&rurl=http%3A%2F%2Fwww.openabdomen.org%2F7-PUB%2F436-jcbs%2F437txt.html&size=86.0kB&name=MS+436+Jacobs+03.jpg&p=peritoneum&type=jpeg&no=211&tt=672&oid=e2d8346f3c45ebf0&ei=UTF-8
http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D201&w=640&h=480&imgurl=www.openabdomen.org%2F7-PUB%2F436-jcbs%2FPics%2FMS%2520436%2520Jacobs%252003.jpg&rurl=http%3A%2F%2Fwww.openabdomen.org%2F7-PUB%2F436-jcbs%2F437txt.html&size=86.0kB&name=MS+436+Jacobs+03.jpg&p=peritoneum&type=jpeg&no=211&tt=672&oid=e2d8346f3c45ebf0&ei=UTF-8

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Microscopie

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http://images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperitoneum%26ei%3DUTF-8%26fr%3Dslv8-msgr%26b%3D181&w=238&h=167&imgurl=www.multi-med.com%2Fpdigifs%2Fpdi20s3%2Ffig223.JPG&rurl=http%3A%2F%2Fwww.multi-med.com%2Fpdigifs%2Fpdi20s3%2Ffigs%2F223.html&size=13.2kB&name=fig223.JPG&p=peritoneum&type=jpeg&no=192&tt=672&oid=5617a35d50c36774&ei=UTF-8

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