PERITONITIS

Name of participants

1.SULLY SIMKOKO2.ROCHIUS MODEST3.ALEX LIPENDELE4.PHILIP JOHN5.ALPHA KWILASA

Outline• Introduction • Etiology• Classification• Pathophysiology• Clinical presentation• Work up • Management• Complication • Prognosis • References

INTRODUCTION

• Peritonitis is the inflammation of the peritoneum

• The peritoneum is the serous membrane which encloses the abdominal cavity and its contents

Parietal peritoneumVisceral peritoneum

Etiology

• InfectiousBacteria eg. E. coli, streptococcus (aerobes &

anaerobes), etcNon bacteria eg. Fungal and virus

• Non infectiousChemical peritonitis eg. gastric acid, bile and blood

CLASSIFICATION

• Anatomical• Etiological• Pathological • Clinical

Anatomical classification Localized peritonitis

Factors which favor localized peritonitis -compartmentalization of abdominal cavity

-pathological factor -surgical factor

Diffused/generalized peritonitisFactors

-sudden visceral perforation-vigorous peristalsis-immune compromised pt-age(infants)-poor handling of localized infection

Etiological classificationInfectious peritonitis

-bacterial -non bacterial

Non infectious(chemical) peritonitis

Pathological classification

Primary peritonitis-due to spontaneous bacterial invasion of

peritoneumSecondary peritonitis

-due to loss of integrity of the GIT Tertiary peritonitis

-due to persistence/ recurrence of peritonitis after adequate control of primary or secondary peritonitis

Clinical peritonitis

Acute peritonitis-this is of sudden onset eg bacterial peritonitis

Chronic peritonitis-present with gradual onseteg TB peritonitis

PATHOPHYSIOLOGY

Absorption of irritantStimulation/activation of immune systemLocalization of infection by host defense

Clinical stages of peritonitis

Peritonism/irritation Reaction Diffuse peritonitis

CLINICAL PRESENTATION

History Physical examination

History/symptoms

Abdominal painAnorexia Nausea and vomitingFeverConstipation

Physical examination

General examinationSystemic examination

General examination

Shallow breathingDehydrationTachycardiaTachypnoic Febrile above 38 degree of centigrade Hypotension Toxic with ‘facies Hippocratic’ Features of septic shock

facies Hippocratic

Abdominal examination

Distended abdomen Failure of abdomen to move with respiration Abdominal Tenderness Muscle guarding/rigidity Rebound tenderness or Blumberg sign Decreased or no bowel sound

WORKUP

Laboratory studies Imaging studies Diagnostic procedures

Laboratory studies

FBP and ESRSerum electrolyteSerum createnin and blood ureaSerum amylase C-reactive proteinBlood grouping and X-matchBlood gases

Imaging studies

Plain thoraco-abdominal X-ray (erect) Abdominal USS Abdominal CT Scan MRI

Diagnostic procedures

Peritoneal fluid aspiration-For gram stain, culture and sensitivity

Laparoscopic investigation

MANAGEMENT

• Principles of treatment • Modalities of treatment

Principles of treatment

Control of source of infectionElimination of bacteria and toxinsMaintain organ system functioningTo control inflammatory process

Modalities of treatment

Conservative treatmentSurgical treatment

Conservative treatment

Oxygen 5Ltr/Min Nil per oralFluid recitation NGT for decompression CatheterizationIV antibioticsAnalgesia Steroids

Surgical treatment

Pre-op preparationIntra-op management Post-op management

Intra op management

Surgical incisionCorrect the source of infectionPeritoneal lavageFix the drainage Close the abdomen

Post op care

IV fluidsNGTAntibioticsAnalgesia Monitoring

COMLICATION

Systemic complications abdominal Complication

Systemic complications

SepticemiaSeptic shockRenal failureElectrolyte imbalanceMulti-organ failureRespiratory infection DIC DVT

Abdominal Complication

Abdominal-pelvic abscessAdhesions Paralytic ileus Tertiary peritonitis Liver abscess

PROGNOSIS

Depends on the following factors-age -sex-peritoneal score system

APACHE II scoreSimplified physiology ScoreSepsis severity scoreMannheim peritonitis score

-development of tertiary peritonitis

References

Bailey & love 25th Edwww.medscape.com SRB manual of sugery 3rd edition by Spiram

Bhat MTertiary peritonitis

www.ncbi.nlm.nih.gov/pubmed/9451931

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