CHAPTER I

INTRODUCTION

Describe the state of emergency abdominal clinic due to gravity in the abdominal cavity which usually occurs suddenly with pain as a chief complaint. This situation requires an immediate response is often in the form of surgery, such as in perforation, intra-abdominal hemorrhage, infection, obstruction and strangulation of the gut can lead to perforation which resulted in contamination of the abdominal cavity by the contents of the gastrointestinal tract that occurs peritonitis. Inflammation of the peritoneum is a dangerous complication that often occurs due to spread of infection from the abdominal organs (eg, appendicitis, salpingitis, perforated gastroduodenal ulcers), gastrointestinal rupture, postoperative complications, chemical irritation, or penetrating injuries abdomen. In normal circumstances, the peritoneum resistant to bacterial infection (by inoculation of small-scale); ongoing contamination, bacterial virulence, resistance decreases, and the presence of foreign objects or active digestive enzymes, are all factors that facilitate the peritonitis.3 The decision to perform surgery should be taken because any delay will cause disease resulting in increased morbidity and mortality. The accuracy of diagnosis and mitigation depends on the ability to analyze data on medical history, physical examination and penunjang.3, 7 In writing Referat will be discussed on the handling of peritonitis. Peritonitis is attributed to the abnormalities in the abdomen in the form of inflammation and penyulitnya, also by obstructive ileus, ischemia and bleeding. Some disorders are caused by direct or indirect injuries resulting in gastrointestinal perforation or perdarahan.

Sheets left and right ventrale mesentery. 2. called the lamina visceralis (tunica serosa).Fascia that covered the walls of the intestine. In between the two cavities are entoderm which is enteron wall. Mesentery is divided into the mesentery and mesenteric ventrale dorsale. Enteron abdominal region into the intestine.CHAPTER II THEORY and DISCUSSION II. The peritoneum is the lamina lateral mesoderm that remain epithelial. Second cavity mesoderm. so that the mesoderm then becomes peritoneum. Ventrale mesentery contained in the next caudal pars superior duodeni then disappeared. Gazette visceralis lamina connecting the right and left parietal lamina sticking together and forming a duplex sheet called duplikatura. dorsal and ventral colon closer to each other. Thus in both ventral and dorsal colon there is a duplikatura.2 viscera in the cavity. which still exist. At the time perkambangan and growth. the mesoderm is the wall of a cavity that is coelom. Lamina connecting 3. ventriculus and intestinal .Fascia visceralis and parietal lamina.1.DEFINITION Peritonitis is inflammation of the peritoneum which is wrapping perut. Duplikatura connects the intestine with walls of ventral and dorsal abdominal wall and can be seen as a tool hanger intestines called the mesentery. Ventrikulus high mesentery called mesogastrium ventrale and mesogastrium dorsale. are united on the edge kaudalnya.Fascia that lines the abdominal wall is called the parietal lamina. Peritoneum is divided into three layers. Peritonitis is an inflammatory or suppurative response of the peritoneum caused by chemical irritation or bacterial invasion. namely: 1. At the beginning.

These relationships form a tube called the ductus omphaloentericus. and is now the so-called retroperitoneal dorsal peritoneum. The folds can also terjadfi because it runs the blood vessels. superior mesenterica respectively in the ventral wall and the dorsal abdominal wall. Cavity called the cavum peritonei. called intraperitoneal located. Processus vermiformis located intraperitoneally with a hanger mesentery. In many places. there are parts that do not have bowel tools hanger again. resulting in the notches between the colon (covered by peritoneum viscerale) and peritoneal parietale or between the mesentery and peritoneal parietale restricted folds. The transverse colon is intraperitoneal and have mounting tool called the transverse mesocolon. Colon sigmoideum located intraperitoneally with a mesosigmoideum. After ductus omphaloentericus disappears. Intestinal growing faster than the cavity so that the intestine had occurred twistingsepulcher sepulcher. Jejenum and ileum located intraperitoneally with a hanger mesentery. The parts that still have the tool hanger is located inside the wall cavity formed by the peritoneum parietale. He is actually a continuation of the cecum. . Because sepulcher intestine rotates. However. adhesions occur. it falls down sepulcher intestine and mesentery dorsale closer together parietale peritoneum. thus: The duodenum is retroperitoneal. a fold of peritoneum due to the artery leading to the end of the processus vermiformis. In places viscerale peritoneum and mesentery dorsale approach dorsale peritoneum. viscerale peritoneal adhesions in the peritoneum or mesentery parietale not perfect. Colon ascendens and colon descendens located retroperitoneal. Enteron gut or in a place associated with the umbilicus and saccus vitellinus. Thus there are at flexura duodenojejenalis plica superior duodenal recess duodenal limit superior and limit inferior plica duodenal duodenal resesus inferior. As a result of this attachment. Sepulcher intestine due to intestinal turned to the right by 270 ° with the axis ductus omphaloentericus and a. cecum lies intraperitoneal due at the beginning of a bulge the walls of the intestines and does not have the tools.playback. not all the happening places of attachment. the colon adjacent to the oral (cranial) sepulcher move to the right and the next anal (caudal) move to the left and both approach parietale peritoneum.

most mesogastrium dorsale approach perietale peritoneum and grow attached. thus curvatura major in minor curvatura the left and the right. Choledocus duct formed by the duct and ductus hepaticus communis cysticus. Lesser omentum attached to the fossa sagittalis sinistra dorsokranial and surrounds part portae hepatis. causing the building called epiploicae Appendices. hepatica propria in the second dorsal side of this building in the middle of running v. Peritoneum covering the colon folds and unfolds out filled with fat. Pockets formed by him called omentalis stock. entered in the fossa sagittalis sinistra hepatis and ends on ramus sinistra portae vein. Autonomic nerve fibers. walk through the ligament to kaudomedial. Stratum circulare coli folds and unfolds so happens plica semilunaris. Arteria hepatica propria. Ventriculus rotate the longitudinal axis. Mesogastrium ventrale attached to the ventral abdominal wall parietale peritoneum and the diaphragm. Terkaudal close attachment part that runs trasversal transverse mesocolon. Falciforme ligament attached to the boundary between the lobe lobe dexter and sinister. Thus mesogastrium dorsale attachment for an arc from left to right cranial caudal. portae. Lympha vessels.In the colon there descendens paracolici recess. Then ventriculus play against the sagittal axis. In the colon there sigmoideum intersigmoideum recess between the peritoneum and mesosigmoideum parietale. Ligamentum teres hepatis sinistra the rest of the umbilical vein. so that the cardia and pylorus move to the left to the right. In the free edge of the lesser omentum or ligament hepatoduodenale are: Vena portae. Ductus choledochus. Ventriculus because they rotate. extending from the umbilicus to the liver in the free edge of the ligament falciforme hepatis. In the liver ventrale mesogastrium formed and evolved. Liver evolved into caudal to the edge of the lesser omentum mesogastrium called or ligament hepatogastricum the next caudal edge freely called hepatoduodenale ligament. menyilangi adjacent dorsal pars superior . Caudal section also occurs mesogastrium dorsale attachment to the transverse mesocolon and omentum called magi. On the left runs a.

especially to the left. . The two sheets of folds that grow attached caudal section. In the adjacent ventral cauda greater amentum pancreatis lien form and grow towards the left so that it is covered in large part by greater amentum left sheet. Stock omentalis own restricted: Cranial section by hepatic caudate lobe Ventral section by the lesser omentum and ventriculus Caudal section by mesocolontransversum and transverse colon Dorsal section by parietale peritoneum covering the caput and corpus pancreatic On the left by a greater amentum with pancreatic cauda and lien Magi omentum attached to the caudal colon tansversum cover of next vental intestine as a curtain to then fold into the cranial direction and attached to major curvatura ventriculi. but still within the cauda pancreatis greater amentum. Because the lien grow. second right sheet ligamentumtidak until the lien attached. Part bursae omentalis terkranial called bursae omentalis superior recess. The part that does not grow is a continuation omentalis called bursae bursae omentalis inferior recess. Magi omentum is divided in two by a ligament precholienale lien.hepatoduodenale Caudal section by pars superior duodeni Dorsal section by parietale peritoneum covering the inferior vena cava. Because most mesogastrium dorsale mesoduodenum and grow attached to the peritoneum parietale. while the sheet is attached to the left from the hilum surrounded lien.duodeni up in the sulcus between the pars descendens duodeni and caput pancreatis duodeni major tributaries of the papillae. Into the hole called the foramen epiploicum omentalis stock (Winslowi) is limited: Cranial section by caudate processus Ventral section by lig. In the mesentery and duodenum (mesoduodenum) and mesogastrium dorsale going and growing pancreas. ligament gastrosplenic section between lien and ventriculus. Because there was a change in the location of the stock omentalis ventriculus. the lien and the peritoneum covering the diaphragm parietale. caput and corpus-located pancreatis retroperitoneal.

The peritoneum is a smooth easy movement of intra peritoneal tools to one another. Divided into sections visceral.ANATOMY Abdominal wall containing structures musculo-aponeurosis complex.5 Organs located in the peritoneal cavity of gastric.Plain coated peritoneal mesothelium. pancreas. Viserale peritoneum that surrounds the abdominal organs are innervated by the autonomic nervous system and is not sensitive to palpation or cutting. The state is called situs inversus. 6. m. The peritoneum is a single layer of cells on the basis fibroelastik mesoepitelial. slick and slippery due to increased peritoneal fluid mengeluiarkan bit. Pain is felt like a stabbing or slashed. The transverse . sigmoid colon. The back of the structure is attached to the upper spine to the ribs. the peritoneum can be likened to the stratum synoviale in joints.7 II. consisting of layers of skin and sub kutis kuitis. Obliquus external abdominis. jejenum. the tools should be located on the right side to the left or vice versa. Thus. Fluid and electrolyte small can move both directions. cecum. duodenum. spleen. kidney and ureter (retroperitoneum ). sub-cutaneous fat and superficial facies (facies skarpa).2. and parietal parts that lines the abdominal wall and fascia associated with muskularis. or excessive contraction of muscles causes ischemia eg colic or inflammation such as appendicitis. Total peritoneal surface area of about 2 meters. transverse colon. that covers the intestines and mesentery. Molecules larger diaphragm cleared into mesothelium and lymphatic through stomata kecil. Thus incision or suturing of the intestine can be done without perceived by the patient. pemuntaran ventriculus and intestine sepulcher going in the other direction. from outside to inside. As a result. then there will be pain. then the third abdominal wall muscles m. Obliquus internus abdominis and m. pressure. Sometimes. However. ascending colon and descenden. ileum. and its activity is consistent with a semipermeable membrane. Patients who merasaka visceral pain usually can not pinpoint the location of the pain that he usually uses his hand to assign it to all areas of pain. The abdominal wall consists of various layers. when performed organ pull or strain. 4 Parietale peritoneum innervated by peripheral nerves. and appendix (intraperitoneum). liver. and at the bottom of the pelvis. so that pain can arise due to the stimuli in the form of palpation. and patients can pinpoint the location of pain. gallbladder fellea. or inflammatory processes.

flour). streptococcus. urine. E.PATOFISOLOGI The initial reaction to invasion by bacteria peritoneum is a discharge of fibrinous exudate. Pneumococus.thorakalis VI . From there a caudal. Proteus.9 II.Kimiawi: sap stomach. The release of various . Wealth vascularization allows horizontal and vertical abdominal incision without causing interference perdarahan. but it can persist as fibrous bands.XII and n. or iatrogenic. abdominal typhoid perforation.Etiology Peritonitis can be caused by abnormalities in the abdomen such as inflammation and perforation penyulitnya appendicitis. b. which stick together with the surrounding surface so as to limit the infection.6 Innervation of the abdominal wall in segmental dipersyarafi by n. blood.2 a. preperitonial fat and peritoneum. it can lead to cell death. The attachment usually disappears when the infection disappear. and external pudendal a. From kraniodorsal acquired bleeding from aa branch.Bakterial: Bacteroides.abdominis.3. acquired. foreign body (talc.6 Abdominal wall to form the abdominal cavity that protects the contents of the abdominal cavity. Another function of the abdominal wall was breathing well on the process of urination and defecation with elevated intra-abdominal pressure. coli. the fascia transversalis. perforated peptic ulcers. which later can lead to intestinal obstuksi. Intercostalis VI .XII and a. Abdominal wall bleeding from several directions. Muscles on the front of the center consists of a pair of the rectus abdominis muscle with fascianya which are separated by the midline linea alba. Obstructive ileus and bleeding due to perforation of a hollow organ due to trauma abdomen. KlebsiellaEnterobacter group. 2. and pancreas. Pockets of pus (abscess) formed between fibrinous adhesions. The integrity of layers musculo-aponeurosis abdominal wall is very important to prevent congenital hernia occurs. superior epigastric.6 II. inferior epigastric.4. Cause inflammation and fluid accumulation due to capillary membrane leak. a. and finally layered preperitonium and peritoneum. sircumfleksa superficial. If the fluid deficit is not corrected quickly and aggressively. bile.3. iliaca a. Mycobacterium Tuberculosa. lumbar I.

and malaise followed by . Hypovolemia increases with an increase in temperature. intestine then becomes Atoni and stretch. If infected material is widespread on the surface of the peritoneum or when the infection spreads. Abdominal typhus is an acute infectious intestinal disease caused by the bacteria S. Tachycardia initially increase cardiac output. and vomiting. but it soon failed so happens hypovolemia. Ileus Ileus may be as simple as intestinal obstruction that is not accompanied pinched blood vessels and can be total or partial. further increasing intra abdominal pressures. Trapping fluid in peritoneal cavity and intestinal lumen. resulting in dehydration. The collection of fluid in the peritoneal cavity and intestinal lumens and edema around the intra peritoneal organs and abdominal wall edema including retroperitoneal tissue causing hypovolemia. can start hiperinflamatorius response. shock. so as to bring to the further development of the failure of many organs. ileal perforation in typhoid fever usually occurs in patients who have a fever for more than 2 weeks accompanied by headache. the input that does not exist. which ends with necrosis or gangrene and perforation of the intestine and eventually occur due to the spread of bacteria on the abdominal cavity so it can happen peritonitis. reduced peristaltic activity to arise paralytic ileus. waste products also accumulate.mediators. cough. some into keusus smooth and achieve plaque peyeri lymphoid tissue in the terminal ileum that experienced bleeding complications in this place hypertrophy and intestinal perforation may occur. making a full effort into breathing difficult and causing decreased perfusion. Adhesions can form between the intestine arches that stretch and can interfere with the recovery of bowel movement and cause intestinal obstruction. Typhi that enter the human body through the mouth from contaminated food and water. such as interleukins. circulatory disorders and oliguria. it can arise generalized peritonitis. Because the body tries to compensate by way of retention of fluid and electrolytes by the kidneys. Lost fluids and electrolytes into the intestinal lumen. 5 The organs in the peritoneal cavity including abdominal wall had edema. Edema caused by capillary permeability organs are rising. Some germs destroyed by stomach acid. 1 Long intestinal blockage or obstruction in the intestines can cause ileus due to mechanical disruption (blockage) then an increase in intestinal peristalsis in an effort to overcome these barriers. on stangulasi ileus accompanied pinched blood vessel obstruction causing ischemia. With the development of generalized peritonitis.

the pain in the shoulder show excitability peritonium be mengenceran stimulates acid salt. ranging from the nature of gastric chemistry until the colon that contains feces. no bacterial infection. tenderness. fekalit. no early symptoms because microorganisms need time to breed new after 24 hours of onset of symptoms of acute abdomen because stimulation peritonium.1 In appendicitis usually is usually caused by a blockage of the lumen of the appendix by hyperplasia of lymphoid follicles. this will reduce the complaints for a while until it happens peritonitis bakteria. especially felt in the epigastric region due to stimulation of peritoneum by stomach acid. Patients who experience severe pain perforation looks like being stabbed in the stomach. but the elasticity of the wall of the appendix has limitations that led to increased intraluminal pressure and impede lymph flow resulting in edema. Then spread throughout the abdomen causes pain all over the abdomen in early perforation. and venous obstruction that edema increases then the flow impaired arterial wall infarction appendix will be followed by necrosis or gangrene of the appendix wall. mucosal ulceration. This pain arises suddenly. such as the stomach region will occur immediately after the trauma and stimulation will occur while the symptoms of severe peritonitis when the bottom such as colon.4 Perforation of peptic ulcer characterized by stimulation of peritoneum which began in the epigastrium and extends throughout the peritoneum caused by generalized peritonitis.abdominal pain. 7 .7 In both abdominal trauma and abdominal penetrating trauma blunt abdominal trauma can lead to peritonitis. sometimes called phase phase chemical peritonitis. When perforation occurs at the top.1. and bile or pancreatic enzymes. sepsis when the intra peritonial hollow organs. Perforation of the stomach and duodenum front causing acute peritonitis. and the general state of decline due to toksemia. causing perforation and peritonitis eventually lead to both local and general. foreign body. Chemical stimulus onset fastest and slowest feces. the longer the mucus is more and more. Peritonial stimuli arising in accordance with the contents of the hollow organs. defans muscular. stricture due to fibrosis and neoplasms. diapedesis bacteria. Obstruction causes mucus produced mucosal dam experience.

The reason is monomikrobial. Germs can be derived from: .Non specific: for example. Besides an extensive and long-contamination of bacteria also can aggravate peritonitis. Sreptococus or Pneumococus.CLASSIFICATION Based on the pathogenesis of peritonitis can be classified as follows: a. for example: . Risk factors that contribute to this is the presence of malnutrition peritonitis.II. especially Bacteroides species.Spesifik: eg Tuberculosis 2. . perforation of the intestine so that the feces out of the colon.Peritonitis tertiary. Coli. intraabdominal malignancy. Peritonitis is bacterial contamination haematogenously the peritoneal cavity and found no focus of infection in the abdomen. b. which carry germs from the outside into the peritoneal cavity. a single organism will not cause a fatal peritonitis.Perforation of the organs in the abdomen. High-risk groups are patients with nephrotic syndrome. chronic renal failure. c. can magnify the effect of aerobic bacteria causing the infection. and hepatic cirrhosis with ascites.Peritonitis acute bacterial secondary (supurativa) Peritonitis which follows an acute infection or gastrointestinal perforation tractusi or urinary tract. Synergism of multiple organisms can aggravate this infection. systemic lupus erythematosus. such as appendicitis.Complications of the inflammatory process intra-abdominal organs.Peritonitis primary bacterial . non-tuberculosis pneumonia an Tonsillitis. namely: 1. In general. and splenectomy. such as peritonitis caused by chemicals.5.Wound / trauma penetration. Bakterii anaerobes. immunosuppression. . usually E. Primary bacterial peritonitis is divided into two.

such sepertii bile. pancreatic lymph.Peritonitis caused by fungi -Peritonitis source of the bacteria that can not be found.Granulomatous peritonitis .Aseptic / sterile peritonitis . Peritonitis is caused by direct irritants.Peritonitis Other forms of peritonitis: . d.Talc peritonitis . lymph gastric.. and urine.Hiperlipidemik peritonitis .

laboratory and X-Ray. spread. septic. or straining. moderate granulomatous peritonitis . appendicitis).1. Lots of pain if the pain is driven as palpation. liver dullness may disappear due to the free air under the diaphragm. abdominal pain.CLINICAL The presence of blood or fluid in the peritoneum cavity will give a sign . Decreased bowel peristalsis is lost due to temporary paralysis usus. abdominal distension. vomiting. or tests lainnya. Peritonitis can be local. breathing. and abdominal distention.1 This stimulation causes pain on any movement that causes a shift in the peritoneum peritoneum. patients usually exhibit other signs and symptoms are nausea. Clinical features for non bacterial peritonitis with acute bacterial peritonitis. severe.a sign stimulus peritoneum. Pain is a sudden. and neurogenic). When bacterial peritonitis has occurred. shock (hypovolemic.CHAPTER III CLINICAL DIAGNOSIS III. 1. severe peritonitis and types of organisms responsible. pain and loose bowel press decreased or disappeared. Clinical features that are common in the presence of primary bacterial peritonitis. and then gradually spread from the focus of infection. the patient's body temperature will rise and occurs tachycardia. While the clinical picture in secondary bacterial peritonitis is the existence of acute abdominal pain. or the public. Stimulation peritonium defans cause tenderness and muscular. coughing. psoas tests. Pain is a subjective form of pain with movement such as walking.. fever. weight loss.3 Chronic bacterial peritonitis (tuberculous) gives an overview of the clinical presence of night sweats. The clinical features depend on the extent of peritonitis. the pain at first because the main cause. the pain being spread throughout the abdomen. and the patient was lethargic and syok. weakness. diffuse or general. abdominal tenderness and rigidity of the local. tenderness loose. fever. and in patients with perforation (eg perforated ulcer). In other situations (eg. hypotension. In addition to pain. and classical bowel weakened or disappeared . DIAGNOSIS Diagnosis of peritonitis can be enforced by the clinical.

When water is short-fluid level layout means there ileus . if the cause is a disturbance passage intestine (ileus) obstructive then on plain abdominal radiological 3 positions available are: 1. In tuberculosa peritonitis peritoneal fluid contains a lot of protein (more than 3 gram/100 ml) and many lymphocytes. if possible.Sleep. thickening dnding intestine.3 Prior to the peritonitis. with a horizontal beam projection AP. III. Shooting should be made using the film cassette that can cover the entire abdomen and its walls. preperitonial fat. In plain abdominal peritonitis done three positions.Skewed to the left (left lateral decubitus = LLD). small intestine and large intestine dilated. X-Ray Ileus is a discovery that is not typical of peritonitis. with a horizontal beam. c. 2. Of water fluid level can be expected passage of intestinal disorders. and is the basis of culture results obtained before diagnosis. AP projection. Free air can be seen in cases of perforation. Need to set the size of the tape and the film size 35 x 43 cm. to see the fluid level and the possibility of bowel perforation. the rays of the vertical projection of anteroposterior (AP). presence or absence of propagation. namely: 1. 2. b. increased hematocrit and metabolic acidosis.Or half sitting or standing. identified with the culture of the tubercle bacillus.laboratory test In laboratory tests found the lekositosis. Picture obtained by the dilation of intestinal obstruction in the proximal region. to see the distribution of the intestine.Backs (supine). such as fish spines picture (Herring bone appearance). Peritoneal biopsy percutaneous or laparoscopic tuberculomas show characteristic granulomas.showed clinical severe abdominal pain. 3.2 Radiological Radiological examination is the investigation for consideration in estimating a patient with an acute abdomen. fever and signs of peritonitis who turned up 2 weeks after surgery.LLD.

ruptured appendix or for any other reason.term possibility of interference in the colon. air fluid levels.Intestinal general. It is located between the heart of the abdominal wall or the pelvis to the abdominal wall. and blurring the abdominal cavity. If prolonged ileus obstructive ileus can be paralitik. The picture obtained is the infra-diaphragmatic free air and water fluid level. Peritonitis due to perforation of the radiological picture can be seen on plain abdominal examination 3 positions. the images are not clear on plain abdomen.sometimes difficult to distinguish between hugely dilated intestinum tenue or intestinum crassum. psoas line disappeared. Picture will be clearer in the USG (ultrasonography) .LLD.term (colon) due to colon lumen diameter wider than the small intestine.high.short (small intestine) and long .Lie. the main radiological signs are: 1.2 In the case of peritonitis due to bleeding. free water obtained subdiafragma crescent (semilunair shadow). Radiological obtained the water fluid level and step ladder appearance.air fluid level . So radiological peritonitis is a vagueness in the abdominal cavity. On the allegation whether due to peptic ulcer perforation. 3. So radiological in obstructive ileus is a partial bowel distension. preperitonial fat and psoas line disappears. 2. and herring bone appearance.Half sitting or standing. . 3.Herring bone appearance The difference with obstructive ileus: intestinal dilation fluid thoroughly so the water level was short . and the presence of free air or intra subdiafragma peritoneal.Sitting or standing. moderate if the long . While in paralytic ileus radiological obtained as follows: . . obtained preperitonial fat disappears. got free water peritonial intra abdominal highest. where a thorough bowel dilation that sometimes .

or a perforated viscus mereseksi. dan dapat menjadi tempat masuk bagi kontaminan eksogen. which is using crystalloid solution (saline). 5. appropriate antibiotics. nutrients. Urine output of central venous pressure.3 Drainase (pengaliran) pada peritonitis umum tidak dianjurkan. If localized peritonitis. Broad-spectrum antibiotics are also additional surgical drainage. Incision is selected vertical incision middle underlined that generate access to the entire abdomen and easily opened and closed.) or other inflammatory causes. an incision above the intended sites of inflammation. Surgery technique used to control contamination depends on the location and nature of pathologic gastrointestinal tract. Antibiotic selection based on which organisms are suspected to be the cause. Bila peritonitisnya terlokalisasi. because bacteremia will develop during the operation. . Returns intravascular volume improve tissue perfusion and delivery of oxygen. 11th Lavase peritoneum performed on the diffuse peritonitis. Agar tidak terjadi penyebaran infeksi ketempat yang tidak terkontaminasi maka dapat diberikan antibiotika ( misal sefalosporin ) atau antiseptik (misal povidon iodine) pada cairan irigasi.11 Disposal of septic focus or other inflammatory performed by laparotomy surgery. and blood pressure should be monitored to assess the adequacy of resuscitation. sebaiknya tidak dilakukan lavase peritoneum.pain relief measures. Antibiotic therapy should be administered as soon as the diagnosis of bacterial peritonitis was made. karena tindakan ini akan dapat menyebabkan bakteria menyebar ketempat lain. Broad-spectrum antibiotics are given empirically. 2. Drainase berguna pada keadaan dimana terjadi kontaminasi yang terusmenerus (misal fistula) dan diindikasikan untuk peritonitis terlokalisasi yang tidak dapat direseksi. and defense mechanisms. gastrointestinal decompression by nasogastric suction and intestinal disposal of septic focus (appendix. In general.3. mengeksklusi. Must be available a sufficient dose during surgery. and then changed its kind after culture results come out. if possible drain the pus out and act.THERAPY The general principle is replacement therapy lost fluids and electrolytes intravenously performed. karena pipa drain itu dengan segera akan terisolasi/terpisah dari cavum peritoneum. etc. Great resuscitation with isotonic saline solution is important. a continuous peritoneal contamination can be prevented by closing.III.

while the general prognosis of peritonitis is lethal due to virulen of organism. . KOMPLIKASI Complication can occur in acute secondary bacterial peritonitis. : a.. hipovolemik shock.DIFFERENTIAL DIAGNOSIS The differential diagnosis of peritonitis is appendicitis. salpingitis.III.4.5. pancreatitis. Advanced complication intestinal obstruction III. where complication can be divided into early and advanced complication. cholecystitis..(hepatic absess) b.6. gastroenteritis. septicemia and septic syok. etc.Prognosis The prognosis for peritonitis is both local and lightweight is fine. ruptured ectopic pregnancy. III. Intra abdominal sepsis that can not be controlled with multi-system failure residua intraperitoneal portal pyemia abcess.

Patofisologi peritoneum peritonitis was the initial reaction to bacterial invasion is the release of fibrinous exudate. infection of the uterus and fallopian tubes. peritoneal dialysis (treatment fails kidney). . We as a nurse in addressing the problem of peritonitis in the community can provide a variety of ways to prevent peritonitis and expected student / i can provide nursing care to clients experiencing particularly peritonitis in accordance with what is learned. The attachment usually disappears when the infection disappear. The peritoneum is a thin. but it can be settled as fibrinous bands. clear membrane covering the abdominal organs and the abdominal wall. b) c) Antibiotic therapy plays a very important role in the treatment of puerperal infection. Analgesic therapy given to treat pain. peritonitis can occur after a surgery. Formed pockets of pus (abscess) among fibrinous adhesions.CHAPTER IV CONCLUSION Peritonitis is inflammation of the peritoneum which is wrapping the viscera in the abdominal cavity. The general principles of therapy in peritonitis are: Replacement of lost fluids and electrolytes made intravenously. The cause of peritonitis include: the spread of infection from an infected abdominal organs. irritation without an infection. Peritonitis are localized only in the pelvic cavity called pelvioperitonitis. d) Surgery include infection of the material and correct the cause. pelvic inflammatory disease in women who are still active in sexual activity. which stick together with the surrounding surface so as to limit the infection. which later can cause intestinal obstruction. abnormal liver or heart failure.

Jakarta: CV Sagung Seto . Textbook of Surgery.Silvia A. 2007. and Sudaryat. . . Price. Supadmi.NANDA Nursing Diagnosis 2005-2006 Prima Medika: Jakarta 3.Peritonitis. 2005.com/med/peritonitis_pyk.php?dktg=7&UID 200 705. Jakarta 2.Gastrointestinal Surgery. Jakarta 4. Some Abnormalities Actions Requiring 7. 2006. ECG. Pathophysiology Clinical Concepts Disease Processes. Aryasa.Wim de Jong.List Pustaka 1.Subanada.System Gastroenterohepatology lectures. http://www. . In: Capita Selekta Gastroenterology Children. 5. EGC.medikastore. Makassar: 2005 6.

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