Acute Suppurative Peritonitis Gu Yan Department of General Surgery
Anatomy of peritoneal cavity Omental foramen Less omentum Stomach Pancreas Duodenum Omental bursa Mesentery of small intestine Greater omentum Rectouterine pouch Vesicouterine pouch Anatomy of peritoneal cavity
Anatomy of peritoneal cavity Peritoneum---parietal peritoneum ---visceral peritoneum Peritoneal cavity in man and woman Nerve innervation of the peritoneum
Acute suppurative Peritonitis Definition of peritonitis Classification of peritonitis Bacterial and nonbacterial peritonitis Acute, subacute and chronic peritonitis Primary and secondary peritonitis Diffuse and local peritonitis
Secondary peritonitis What is secondary peritonitis Organisms in secondary peritonitis Escherichia coli anaerobic bacteroid streptococcus proteus species
Secondary peritonitis Causes of secondary peritonitis: Perforation of gastrointestinal tract or rupture from injuries in the abdominal wall or the intraabdominal viscera Diffuse spreading of the intraabdominal infection within the peritoneal cavity, etc.
Common causes of peritonitis Meckel’s Diverticulitis Acute cholecystitis Meckel’s Diverticulitis
Case report
Primary peritonitis What is primary peritonitis : Diffuse bacterial infection without an apparent intraabdominal source of infection Organisms in primary peritonitis pneumococcus, hemolytic streptococcus, E coli, etc.
Primary peritonitis Routes of bacterial transmission: blood stream ascending direct bacterial transmission transmural spreading
急性弥漫性腹膜炎－病理生理 细菌或胃肠道内容物进入腹腔－浆液性渗出、细胞因子释放 水、电解质、酸碱平衡紊乱，细胞外液↓ 肠麻痹、心肺功能衰竭，休克 腹膜炎结局依赖于机体自身防御能力与细菌毒力二方面
急性弥漫性腹膜炎－临床表现 临床表现： 腹痛；恶心、呕吐；体温、脉搏变化；感 染中毒症状 腹部体征：｀ 腹胀，腹式呼吸减弱或消失 腹痛；恶心、呕吐；体温、脉搏变化；感 染中毒症状 腹部体征：｀ 腹胀，腹式呼吸减弱或消失 腹部压痛、反跳痛、肌紧张－腹膜炎标志 体征 肝浊音缩小或消失，移动性浊音 肠鸣音减弱或消失 直肠指检：直肠前壁饱满或触痛
急性弥漫性腹膜炎－辅助检查 血常规检查：WBC，N： 腹部立卧位平片： B超： 诊断性腹腔穿刺或腹腔灌洗 CT检查 直肠指检，阴道检查或后穹隆穿刺检查
急性弥漫性腹膜炎－临床诊断 症状、体征与辅助检查 注意区别原发与继发性腹膜炎 急性腹膜炎的治疗 非手术治疗 适应征: 方法：
急性弥漫性腹膜炎－治疗 手术治疗 适应症： 手术治疗三原则： 1，原发病处理 2，彻底清理腹腔 3，充分引流 手术引流指征
腹腔脓肿 膈下脓肿(subpherenic abscess) 膈下间隙分区： 经皮穿刺插管引流：表浅、局限、单房 病理与转归： 病理与转归： 临床表现：全身表现明显，局部症状较轻 诊断与鉴别诊断：X-ray、B超、CT 治疗方法： 经皮穿刺插管引流：表浅、局限、单房 切开引流：经前腹壁肋缘下、经后腰部切口
腹腔脓肿 盆腔脓肿(pelvic abscess) 肠间脓肿(interloop abscess) 临床表现：局部症状明显，全身症状轻 体温不降、直肠或膀胱刺激症状 诊断：直肠指诊，阴道检查、B超、CT 治疗：非手术与手术治疗（经直肠、阴道） 肠间脓肿(interloop abscess) 临床表现：感染及腹部症状 诊断：X-ray、B超、CT 治疗：非手术与手术治疗