上海交通大学医学院外科学各论（英文）课件第五章急性化脓性腹膜炎

Peritonitis,Peritonitis,Infection, or rarely some other type of inflammation, of the peritoneum. Peritoneum is a membrane that covers the surface of both the organs that lie in the abdominal cavity and the inner surface of the abdominal cavity itself.,Clinical Manifestations,Early or diffuse infection results in localized or generalized peritonitis. Late and localized infections produces an intra-abdominal abscess.,2 Major Types,Primary: The spread of an infection People who have an accumulation of fluid in their abdomens (ascites). The fluid that accumulates creates a good environment for the growth of bacteria.,2 Major Types,Secondary: The entry of bacteria or enzymes into the peritoneum Ulcer , appendix or a ruptured diverticulum. An intestine to burst or injury.,Attention!,Both cases are very serious & can be life threatening if not treated properly!,Hollow Organs,Hollow organs are more susceptible to athletic injury when they are full of waste & food products. Injury to a hollow organ may so signs of: black tarry stool bright red blood in the fecal discharge bloody vomitus,Signs & Symptoms,Breathing & Heart Rates Shallow Breaths Low BP Limited Urine Production Inability to pass gas or feces,Swelling & tenderness in the abdomen Fever & Chills Loss of Appetite Nausea & Vomiting,Symptoms,An acutely ill patient tends to lie “very” still because any movement causes excruciating pain. They will lie with there knees bent to decrease strain on the tender peritoneum.,Exam & Evaluation,Feel & press the abdomen to detect any swelling & tenderness in the area as well as signs of fluid has collected in the area. Listen to the bowel sounds & check for difficulty breathing, low blood pressure & signs of dehydration.,Evaluation,The usual sounds made by the active intestine and heard during examination with a stethoscope will be absent, because the intestine usually stops functioning. The abdom may be rigid and boardlike Accumulations of fluid will be notable in primary due to ascites.,Exams,Blood Test Samples of fluid from the abdomen CT Scan Chest X-rays Peritoneal lavage.,Treatment Approach,Hospitalization is common. Surgery is often necessary to remove the source of infection. Antibiotics are prescribed to control the infection & intravenous therapy (IV) is used to restore hydration.,Treatment Approach,Morphine for pain. Dietary supplements (omega 3, omega 6 fatty acids, vitamin A, E, C, and zinc),Prognosis,Untreated peritonitis is poor, usually resulting in death. With Tx, prognosis is variable, dependent on the underlying causes.,Preventive Care,There is “NO WAY” to prevent peritonitis, since the diseases it accompanies are usually not under the voluntary control of an individual. However, the