Peritonitis: Introduction and Management

Peritonitis: Introduction and Management

+ [email protected] @wannabehawkeye Peritonitis: Introduction and Management Mr M Lee, Clinical Research Fellow in General Surgery + Outline What Why

is it important? What How is peritonitis? are the causes? do we treat it? + Peritonitis is Inflammation of the peritoneum

+ Causes of peritonitis Type Causative agent Possible cause Bacterial Gram negative (coliforms) Gram positive (Staphylococcus)

Perforated viscus Spontaneous bacterial peritonitis Chemical Bile Bile leak (post-op) Haematologic Blood Ruptured ectopic pregnancy

+ Intraperitoneal space The peritoneum can hold >5L of fluid/pus/blood Large absorptive area + Peritoneum Visceral Parietal Location On organs

Abdominal wall Innervation Autonomic Somatic Sensation Poorly localised Well localised Foregut

Midgut Hindgut Anatomical limits Lower oesophagus to D2 D2 to 2/3 across Transverse colon

Transverse colon to upper rectum Site of autonomic pain Epigastric Periumbilical Suprapubic +

History Sudden onset (perforation) Poorly localised moving to one point of abdomen Lying still Speedbumps Rest

my hand on it its better or beg you not to examine + Clinical Examination Localised vs generalised Point-tenderness Systemically

vs rigid abdomen shocked + Investigations Blood X-rays CT tests of chest and abdomen scan of abdomen B-HCG!

ECG + Treatment ABC Treat the underlying cause and treat it early Call a surgeon Source control Post-management support + Not just a belly problem Complication of peritonitis Hypovolaemia Kidney failure Systemic Sepsis

Paralytic ileus Pulmonary atelectasis/pneumonia Portal pyaemia + Abscess formation Patient position Location of collection Standing Pelvis

Supine Left or right paracolic gutter Suprahepatic/ sub-phrenic Supine + Primary peritonitis + Primary Peritonitis

Spontaneous Bacterial Peritonitis Ascites Immunocompromised (lymphoma/peritoneal dialysis) Diagnosis is an ascitic tap/blood cultures

Treatment is broad spectrum antibiotics No operation! + Secondary peritonitis + Case 1 25 y.o. male

1 day history of umbilical pain, poorly localised, going to right iliac fossa Off food Low grade fever Raised WCC (15).

O/E Rebound tenderness and guarding in RIF + Diagnosis + Case 2 23 y.o. F

Sudden onset low abdominal pain Acutely hypotensive Missed last period Referred to general surgery as ?appendicitis + Diagnosis?

+ Case 3 50 y.o. male Smoker, diabetic Sudden onset abdominal pain, 10/10

Not settling with morphine + Diagnosis? + Case 4 75 year old smoker B/g acid reflux, uses ibuprofen for arthritis

Previous MI Sudden onset epigastric pain Board like abdomen + Diagnosis? +

Important considerations Pre-morbid Assessing status risk (P-POSSUM, ASA) Conservative Palliation treatment + In summary Peritonitis

Toxins are absorbed Systemic Treat is bad upset underlying cause and complications + Further learning

Good for basic knowledge Lecture notes in General Surgery (Ellis, Calne, Watson) Bailey and Loves Short Practice of Surgery Good for quick revision Oxford handbook of surgery Surgery at a glance xperience is the best tutor for emergency surgery and peritoniti t the surgical admissions unit and emergency theatre to learn m [email protected] @wannabehawkeye

Recently Viewed Presentations

  • Blood Vessels (Vascular System) transport blood to tissues ...

    Blood Vessels (Vascular System) transport blood to tissues ...

    Heart gets blood into Vessels, then. Vessels take over getting blood to cells. BLOOD VESSEL FUNCTIONS. Systemic Blood Pressure (Overall) must be maintained to keep blood moving to all the tissues as a whole ... Myogenic: INTRINSIC. To protect against...
  • Early Elizabethan England 1558-1588 Knowledge Booklet

    Early Elizabethan England 1558-1588 Knowledge Booklet

    The survey of the poor undertaken in Norwich in 1570 showed that 40% of the poor counted were under 16 years old. Families also led by women were also poor. The Problem of the Poor Changing Attitudes Towards the Poor...
  • Christopher Chapman | MCT - download.microsoft.com

    Christopher Chapman | MCT - download.microsoft.com

    What is Authorization? Security principals are issued security identifiers (SIDs) when the account is created. User accounts are issued security tokens during authentication that include the user's SID and all related group SIDs
  • Quick Start Steps

    Quick Start Steps

    Step 2: Review and edit the file. To authorize a user for continued access to the contract, copy the appropriate entitled company from column D or E, and paste it into column C. This will identify the company on behalf...
  • GPU Programming

    GPU Programming

    GPU Programmingusing BU's Shared Computing Cluster. Research Computing Services. Boston University. This version of the slides was updated for the Fall of 2017. This tutorial is an introduction to the use of GPUs and an overview of the various ways...
  • DEV354: Extending Microsoft Visual Studio LightSwitch ...

    DEV354: Extending Microsoft Visual Studio LightSwitch ...

    Extending Microsoft Visual Studio LightSwitch Applications. Beth Massi. ... LightSwitch Extensions are installed like any other Visual Studio extension and managed via the Extension Manager. ... DEV354: Extending Microsoft Visual Studio LightSwitch Applications
  • Cell Structure - MISS PASCIAK'S BIOLOGY

    Cell Structure - MISS PASCIAK'S BIOLOGY

    STERNGRR processes occur in cells! All cells come from pre-existing cells. Cells reproduce to make more cells. Bacteria. ALL cells have. DNA (chromosomes) Cytoplasm. Ribosomes. Cell membrane (aka plasma membrane) Prokaryotic Cells. Ribosomes. DNA . Cell Membrane.
  • Chapter 7

    Chapter 7

    Learning about .NET (Managed Language) tools and type check functions useful to input validation. Use decision-making statements to perform input validation. Given a form that uses text boxes to accept data and the validation specifications for that data, write code...