Acute Suppurative Peritonitis

Presentation on theme: "Acute Suppurative Peritonitis"— Presentation transcript:

1 Acute Suppurative Peritonitis
Gu Yan Department of General Surgery

2 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

3 Anatomy of peritoneal cavity
Peritoneum---parietal peritoneum ---visceral peritoneum Peritoneal cavity in man and woman Nerve innervation of the peritoneum

4 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

5 Secondary peritonitis
What is secondary peritonitis Organisms in secondary peritonitis Escherichia coli anaerobic bacteroid streptococcus proteus species

6 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.

7 Common causes of peritonitis Meckel’s Diverticulitis
Acute cholecystitis Meckel’s Diverticulitis

8 Case report

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10 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.

11 Primary peritonitis Routes of bacterial transmission: blood stream
ascending direct bacterial transmission transmural spreading

12 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

13 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

14 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

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17 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：

18 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

19 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

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21 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