腹膜炎腹腔脓肿ppt课件 (2)

conservative treatment Methods
1) Half lying position: to let the inflammatory
fluid inside abdominal
2) Fasting and gastro-intestinal suction: To avoid
the content inside the digestive tract flowing
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Clinical findings 1. Abdominal pain The main complaint is abdominal, which is
severe and consistent, generally spreading from the lesion point to the whole abdomen. Patient’s breath can be obviously limited.
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Diagnosis
Based on clinical findings and accessory examinations
Treatment
1. Non-operative
Indication: 1) slight peritonitis
2) local signs have got better
Ultrasound: Used to find fluid inside abdominal cavity, and help to localize position of aspiration.
CT: Used to find lesions of pancreas. Abdominal aspiration: same with the previous. Rectum finger examination: To find abscess in pelvic cavity.
2. Etiology
Secondary defuse peritonitis (the most common) ① Acute perforation of gastric and duodenal ulcer ②Gall bladder perforation following acute
cholecystitis ③ Traumatic rupture of intestine and bladder ④ Severe acute appendicitis and pancreatitis ⑤ Anastomotic leakage following operation 5
to stimuli, and the pelvic peritoneum is the area
least sensitive.
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Anatomy and Physiology of the Peritoneal Cavity
Patients with abdominal pain may show tenderness to palpation of the abdomen; and if peritoneal irritation exists, they have rebound tenderness. Localized inflammation of the anterior parietal peritoneum may lead to voluntary muscle guarding. The visceral peritoneum is relatively insensitive and receives afferent innervation only from the autonomic nervous system. Stimuli from the visceral peritoneum are often poorly localized and are perceived as dull or intermittent cramping.
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Acute Generalized Peritonitis
1. Definition: Acute abscess peritonitis pervaded all peritoneal cavity is called acute generalized peritonitis (AGP). Peritonitis, classified as primary or spontaneous peritonitis and secondary peritonitis.
Primary defuse peritonitis 1. Through blood route 2. Upward infection from female oviduct 3. Direct spreading from urinary tract infection 4. Conditional bacteria infection when the function of intestinal membrane barrier decrease.
duration. If the body’s defense system>bacteria’s
invasion ability-------absorbed or localized If the defense system<bacteria’s invasion
ability-------infective shock, MOF, death
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Outcome of acute defuse peritonitis Two factors decide the outcome of acute
defuse peritonitis: One is the ability of body’s defense system Another is bacteria’s quality, number and
2. Nausea and vomiting Because stimulation to peritoneum, the content inside the stomach and intestine may be vomited out reflectively.
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3. Fever and tachycardia The result of reaction to both infective and non-infective inflammation. Sometimes lower temperature means that patient’s conditions is poor or the infection has become worse. 4. Infective shock manifestation Pale complexion, cool extremities, weak pulse, lower blood pressure, and loss of consciousness.
immediately adjacent to and reinforced by the
transversalis fascia. The visceral peritoneum
covers all the intraperitoneal viscera, creating a
completely enclosed cavity except for the open
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2. Operation treatment Indications:
ACUTE ABSCESSE PERITONITIS
Anatomy and Physiology of the Peritoneal Cavity The peritoneal cavity is covered by a single layer of mesothelial cells on connective tissue, including collagen, elastic fibers, macrophages, and fat cells.
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Anatomy and Physiology of the Peritoneal Cavity
The parietal peritoneum, which covers the
abdominal cavity, including the anterior
abdominal wall, diaphragm, and pelvis, is
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5. Abdominal signs Obvious distension and disappearance of abdominal respiration can be noticed. Tenderness, muscular spasm, and rebound pain are typical signs of acute defuse peritonitis, If the peritonitis is caused by gastric or gallbladder perforation, muscular rigidity and absence of peristalsis can be found.
ends of the fallopian tubes. The parietal
peritoneum is innervated by both somatic and
visceral afferent nerves. The peritoneum of the
anterior abdominal wall is the area most sensitive
into abdominal cavity, and alleviate abdominal
distension

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Treatment
3) Correct the unbalance of water and electrolytes Gastric suction and exudation of fluid
inside the intestine may cause the loss of body fluid and electrolytes 4) Application of antibiotics: Try to use
appropriate and sensitive antibiotics 5) Nutrition support 6) Use of sedative drug and oxygen
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Anatomy and Physiology of the Peritoneal Cavity The visceral afferent nerves have no receptors
to mediate pain and temperature but do respond to distention, traction, and pressure. The biliary tract and mesentery have greater innervation than the small intestine. Thus, pain from the gallbladder and common duct is more accurately localized than that from the small intestine.
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Accessory Examination X-ray: Air-fluid level in dilated loops of small
bowel can be found. Free air under the diaphragm indicate perforation of gastro-intestinal tract.