Peritonitis

Ahmad Barrun Nidhom 102010101045

INTRODUCTION
Peritonitis inflamasi peritoneum. Berdasarkan:
Lokasi localized or diffuse; Natural history acute or chronic; Pathogenesis infectious or aseptic

Acute peritonitis biasanya disebabkan infeksi & karena perforasi viscus (secondary peritonitis)

 Pd acute peritonitis intestinal motor activity distention of the intestinal lumen with gas & fluid (adynamic ileus) accumulate deplesi volume intravascular effects on cardiac, renal & othe systems

ETIOLOGY
Infectious agents gain access to the peritoneal cavity through:
Perforated viscus; A penetrating wound of the abdominal wall; External introduction of a foreign object that is or becomes infected (e.g., a chronic peritoneal dialysis catheter).

 Most common causes of bacterial infection:

Ruptured appendix; Ruptured diverticulum; Perforated peptic ulcer; Incarcerated hernia; Gangrenous gall bladder Volvulus; Bowel infarction; Cancer; Infalmmatory bowel disease; Intestinal obstruction

 Aseptic peritonitis due to iritasi peritoneum by:

abnormal presence of physiologic fluids (e.g., gastric juice, bile, pancreatic enzymes, blood or urine) or; Sterile foreign bodies (e.g., surgical sponges or instruments, starch from surgical gloves)

 Aseptic peritonitis can be as a complication of rare systemic diseases such as lupus erythematosus, porphyria, familial Mediterranean fever. Chemical irritation of the peritoneum biasanya due to acidic gastric juice & pancreatic enzymes.

CLINICAL FEATURES
Nyeri abodmen akut & nyeri tekan, biasanya disertai demam. Lokasi berdasarkan penyebab inflamasi: localized or generalized. Localized peritonitis most common in uncomplicated appendicitis (RLQ) & diverculitis LLQ).

 Generalized peritonitis inflamasi luas & nyeri tekan yg difus & rebound; Dinding abdomen = kaku; Tachycardia, hypotension & signs of dehydration; Pd pemeriksaan lab leukositosis & acidosis; Pd CT scan/ultrasonography adanya cairan or abscess.

Therapy & Prognosis

Treatment rehydration, correction of electrolyte abnormalities, antibiotics & surgical correction of the underlying defect. Mortality rates <10% for uncomplicated peritonitis w/ perforated ulcer or ruptured appendix or diverticulum Mortality rates 40% for elderly people, those with underlying illness & when peritonitis present for >48 h.