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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.
Ventrikulus high mesentery called mesogastrium ventrale and mesogastrium dorsale. the mesoderm is the wall of a cavity that is coelom. dorsal and ventral colon closer to each other. Mesentery is divided into the mesentery and mesenteric ventrale dorsale. 2. ventriculus and intestinal . In between the two cavities are entoderm which is enteron wall. Peritoneum is divided into three layers. called the lamina visceralis (tunica serosa). which still exist. At the time perkambangan and growth.1. Thus in both ventral and dorsal colon there is a duplikatura. are united on the edge kaudalnya.Fascia visceralis and parietal lamina.Fascia that lines the abdominal wall is called the parietal lamina.2 viscera in the cavity. Ventrale mesentery contained in the next caudal pars superior duodeni then disappeared. namely: 1. so that the mesoderm then becomes peritoneum. Duplikatura connects the intestine with walls of ventral and dorsal abdominal wall and can be seen as a tool hanger intestines called the mesentery. The peritoneum is the lamina lateral mesoderm that remain epithelial.DEFINITION Peritonitis is inflammation of the peritoneum which is wrapping perut.CHAPTER II THEORY and DISCUSSION II. Lamina connecting 3. Gazette visceralis lamina connecting the right and left parietal lamina sticking together and forming a duplex sheet called duplikatura. Peritonitis is an inflammatory or suppurative response of the peritoneum caused by chemical irritation or bacterial invasion. Sheets left and right ventrale mesentery.Fascia that covered the walls of the intestine. Second cavity mesoderm. Enteron abdominal region into the intestine. At the beginning.
Intestinal growing faster than the cavity so that the intestine had occurred twistingsepulcher sepulcher. . not all the happening places of attachment. The parts that still have the tool hanger is located inside the wall cavity formed by the peritoneum parietale. Thus there are at flexura duodenojejenalis plica superior duodenal recess duodenal limit superior and limit inferior plica duodenal duodenal resesus inferior. Colon ascendens and colon descendens located retroperitoneal. 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. The folds can also terjadfi because it runs the blood vessels. and is now the so-called retroperitoneal dorsal peritoneum. resulting in the notches between the colon (covered by peritoneum viscerale) and peritoneal parietale or between the mesentery and peritoneal parietale restricted folds. In many places. Because sepulcher intestine rotates. He is actually a continuation of the cecum. a fold of peritoneum due to the artery leading to the end of the processus vermiformis. These relationships form a tube called the ductus omphaloentericus. viscerale peritoneal adhesions in the peritoneum or mesentery parietale not perfect. it falls down sepulcher intestine and mesentery dorsale closer together parietale peritoneum. The transverse colon is intraperitoneal and have mounting tool called the transverse mesocolon. After ductus omphaloentericus disappears. However. Cavity called the cavum peritonei.playback. Sepulcher intestine due to intestinal turned to the right by 270 ° with the axis ductus omphaloentericus and a. called intraperitoneal located. Jejenum and ileum located intraperitoneally with a hanger mesentery. In places viscerale peritoneum and mesentery dorsale approach dorsale peritoneum. thus: The duodenum is retroperitoneal. Processus vermiformis located intraperitoneally with a hanger mesentery. Colon sigmoideum located intraperitoneally with a mesosigmoideum. As a result of this attachment. there are parts that do not have bowel tools hanger again. cecum lies intraperitoneal due at the beginning of a bulge the walls of the intestines and does not have the tools. superior mesenterica respectively in the ventral wall and the dorsal abdominal wall. adhesions occur. Enteron gut or in a place associated with the umbilicus and saccus vitellinus.
thus curvatura major in minor curvatura the left and the right. hepatica propria in the second dorsal side of this building in the middle of running v. Thus mesogastrium dorsale attachment for an arc from left to right cranial caudal. Terkaudal close attachment part that runs trasversal transverse mesocolon. In the liver ventrale mesogastrium formed and evolved. Ligamentum teres hepatis sinistra the rest of the umbilical vein. most mesogastrium dorsale approach perietale peritoneum and grow attached. Lympha vessels. so that the cardia and pylorus move to the left to the right. causing the building called epiploicae Appendices. walk through the ligament to kaudomedial. entered in the fossa sagittalis sinistra hepatis and ends on ramus sinistra portae vein. Then ventriculus play against the sagittal axis. Autonomic nerve fibers. Lesser omentum attached to the fossa sagittalis sinistra dorsokranial and surrounds part portae hepatis. Arteria hepatica propria. portae. Mesogastrium ventrale attached to the ventral abdominal wall parietale peritoneum and the diaphragm. Choledocus duct formed by the duct and ductus hepaticus communis cysticus. In the colon there sigmoideum intersigmoideum recess between the peritoneum and mesosigmoideum parietale. Falciforme ligament attached to the boundary between the lobe lobe dexter and sinister. Ductus choledochus. Stratum circulare coli folds and unfolds so happens plica semilunaris. Caudal section also occurs mesogastrium dorsale attachment to the transverse mesocolon and omentum called magi. extending from the umbilicus to the liver in the free edge of the ligament falciforme hepatis. In the free edge of the lesser omentum or ligament hepatoduodenale are: Vena portae. Peritoneum covering the colon folds and unfolds out filled with fat. Pockets formed by him called omentalis stock. menyilangi adjacent dorsal pars superior .In the colon there descendens paracolici recess. On the left runs a. Liver evolved into caudal to the edge of the lesser omentum mesogastrium called or ligament hepatogastricum the next caudal edge freely called hepatoduodenale ligament. Ventriculus rotate the longitudinal axis. Ventriculus because they rotate.
while the sheet is attached to the left from the hilum surrounded lien. especially to the left. 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. Because the lien grow. Part bursae omentalis terkranial called bursae omentalis superior recess. The two sheets of folds that grow attached caudal section. the lien and the peritoneum covering the diaphragm parietale. . ligament gastrosplenic section between lien and ventriculus. Because there was a change in the location of the stock omentalis ventriculus. Into the hole called the foramen epiploicum omentalis stock (Winslowi) is limited: Cranial section by caudate processus Ventral section by lig.duodeni up in the sulcus between the pars descendens duodeni and caput pancreatis duodeni major tributaries of the papillae. In the mesentery and duodenum (mesoduodenum) and mesogastrium dorsale going and growing pancreas. caput and corpus-located pancreatis retroperitoneal. The part that does not grow is a continuation omentalis called bursae bursae omentalis inferior recess.hepatoduodenale Caudal section by pars superior duodeni Dorsal section by parietale peritoneum covering the inferior vena cava. Magi omentum is divided in two by a ligament precholienale lien. but still within the cauda pancreatis greater amentum. second right sheet ligamentumtidak until the lien attached. 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. Because most mesogastrium dorsale mesoduodenum and grow attached to the peritoneum parietale.
when performed organ pull or strain. Viserale peritoneum that surrounds the abdominal organs are innervated by the autonomic nervous system and is not sensitive to palpation or cutting. sigmoid colon. gallbladder fellea. The transverse . and at the bottom of the pelvis. Total peritoneal surface area of about 2 meters. and its activity is consistent with a semipermeable membrane. As a result. Sometimes. then there will be pain. 4 Parietale peritoneum innervated by peripheral nerves. The abdominal wall consists of various layers. and parietal parts that lines the abdominal wall and fascia associated with muskularis. liver.5 Organs located in the peritoneal cavity of gastric. and patients can pinpoint the location of pain. 6. transverse colon. Obliquus external abdominis. or inflammatory processes. cecum. Molecules larger diaphragm cleared into mesothelium and lymphatic through stomata kecil. the tools should be located on the right side to the left or vice versa. m. Divided into sections visceral. 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. consisting of layers of skin and sub kutis kuitis. slick and slippery due to increased peritoneal fluid mengeluiarkan bit. However. Thus incision or suturing of the intestine can be done without perceived by the patient. The peritoneum is a single layer of cells on the basis fibroelastik mesoepitelial.ANATOMY Abdominal wall containing structures musculo-aponeurosis complex. kidney and ureter (retroperitoneum ). Fluid and electrolyte small can move both directions. ascending colon and descenden.7 II. then the third abdominal wall muscles m. Obliquus internus abdominis and m. from outside to inside. pancreas. Thus. so that pain can arise due to the stimuli in the form of palpation. and appendix (intraperitoneum). duodenum. that covers the intestines and mesentery. The peritoneum is a smooth easy movement of intra peritoneal tools to one another. Pain is felt like a stabbing or slashed. pemuntaran ventriculus and intestine sepulcher going in the other direction.Plain coated peritoneal mesothelium. The back of the structure is attached to the upper spine to the ribs. jejenum. pressure. or excessive contraction of muscles causes ischemia eg colic or inflammation such as appendicitis. ileum. sub-cutaneous fat and superficial facies (facies skarpa).2. the peritoneum can be likened to the stratum synoviale in joints. The state is called situs inversus. spleen.
Pneumococus. foreign body (talc. it can lead to cell death. or iatrogenic.XII and n. which later can lead to intestinal obstuksi. preperitonial fat and peritoneum. coli.thorakalis VI . Pockets of pus (abscess) formed between fibrinous adhesions. acquired. b. abdominal typhoid perforation. which stick together with the surrounding surface so as to limit the infection. superior epigastric. a. inferior epigastric.6 Abdominal wall to form the abdominal cavity that protects the contents of the abdominal cavity. and pancreas. iliaca a. E. and external pudendal a. the fascia transversalis.3. The attachment usually disappears when the infection disappear. From there a caudal. urine.Kimiawi: sap stomach. sircumfleksa superficial.Etiology Peritonitis can be caused by abnormalities in the abdomen such as inflammation and perforation penyulitnya appendicitis. Wealth vascularization allows horizontal and vertical abdominal incision without causing interference perdarahan. KlebsiellaEnterobacter group. From kraniodorsal acquired bleeding from aa branch.2 a. and finally layered preperitonium and peritoneum.Bakterial: Bacteroides. Mycobacterium Tuberculosa.PATOFISOLOGI The initial reaction to invasion by bacteria peritoneum is a discharge of fibrinous exudate.3. 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. Intercostalis VI . 2. The integrity of layers musculo-aponeurosis abdominal wall is very important to prevent congenital hernia occurs. blood. perforated peptic ulcers. lumbar I. Proteus. Abdominal wall bleeding from several directions.XII and a. Obstructive ileus and bleeding due to perforation of a hollow organ due to trauma abdomen.6 II. streptococcus. Another function of the abdominal wall was breathing well on the process of urination and defecation with elevated intra-abdominal pressure.9 II. flour). but it can persist as fibrous bands.6 Innervation of the abdominal wall in segmental dipersyarafi by n. If the fluid deficit is not corrected quickly and aggressively. Cause inflammation and fluid accumulation due to capillary membrane leak. bile.abdominis. The release of various .4.
the input that does not exist. shock. but it soon failed so happens hypovolemia. such as interleukins. intestine then becomes Atoni and stretch. 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. resulting in dehydration. Trapping fluid in peritoneal cavity and intestinal lumen. cough. 5 The organs in the peritoneal cavity including abdominal wall had edema. Edema caused by capillary permeability organs are rising. Tachycardia initially increase cardiac output. and malaise followed by . With the development of generalized peritonitis. If infected material is widespread on the surface of the peritoneum or when the infection spreads. 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. reduced peristaltic activity to arise paralytic ileus. 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. Abdominal typhus is an acute infectious intestinal disease caused by the bacteria S. Ileus Ileus may be as simple as intestinal obstruction that is not accompanied pinched blood vessels and can be total or partial. can start hiperinflamatorius response. Typhi that enter the human body through the mouth from contaminated food and water. Lost fluids and electrolytes into the intestinal lumen. circulatory disorders and oliguria. on stangulasi ileus accompanied pinched blood vessel obstruction causing ischemia. Adhesions can form between the intestine arches that stretch and can interfere with the recovery of bowel movement and cause intestinal obstruction. so as to bring to the further development of the failure of many organs. it can arise generalized peritonitis.mediators. Because the body tries to compensate by way of retention of fluid and electrolytes by the kidneys. 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. waste products also accumulate. Hypovolemia increases with an increase in temperature. further increasing intra abdominal pressures. Some germs destroyed by stomach acid. making a full effort into breathing difficult and causing decreased perfusion. and vomiting. ileal perforation in typhoid fever usually occurs in patients who have a fever for more than 2 weeks accompanied by headache.
defans muscular. Then spread throughout the abdomen causes pain all over the abdomen in early perforation. Patients who experience severe pain perforation looks like being stabbed in the stomach. stricture due to fibrosis and neoplasms. and the general state of decline due to toksemia. Chemical stimulus onset fastest and slowest feces.4 Perforation of peptic ulcer characterized by stimulation of peritoneum which began in the epigastrium and extends throughout the peritoneum caused by generalized peritonitis. ranging from the nature of gastric chemistry until the colon that contains feces. and bile or pancreatic enzymes. 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.1.1 In appendicitis usually is usually caused by a blockage of the lumen of the appendix by hyperplasia of lymphoid follicles. no bacterial infection. no early symptoms because microorganisms need time to breed new after 24 hours of onset of symptoms of acute abdomen because stimulation peritonium. Perforation of the stomach and duodenum front causing acute peritonitis. tenderness. 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. diapedesis bacteria. causing perforation and peritonitis eventually lead to both local and general. the pain in the shoulder show excitability peritonium be mengenceran stimulates acid salt.abdominal pain. the longer the mucus is more and more. mucosal ulceration.7 In both abdominal trauma and abdominal penetrating trauma blunt abdominal trauma can lead to peritonitis. This pain arises suddenly. When perforation occurs at the top. 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. but the elasticity of the wall of the appendix has limitations that led to increased intraluminal pressure and impede lymph flow resulting in edema. foreign body. fekalit. Obstruction causes mucus produced mucosal dam experience. 7 . Peritonial stimuli arising in accordance with the contents of the hollow organs. sepsis when the intra peritonial hollow organs. sometimes called phase phase chemical peritonitis.
and splenectomy. The reason is monomikrobial. systemic lupus erythematosus.CLASSIFICATION Based on the pathogenesis of peritonitis can be classified as follows: a.Spesifik: eg Tuberculosis 2. intraabdominal malignancy. Besides an extensive and long-contamination of bacteria also can aggravate peritonitis. Sreptococus or Pneumococus. Peritonitis is bacterial contamination haematogenously the peritoneal cavity and found no focus of infection in the abdomen. and hepatic cirrhosis with ascites. Synergism of multiple organisms can aggravate this infection. Risk factors that contribute to this is the presence of malnutrition peritonitis. High-risk groups are patients with nephrotic syndrome. such as peritonitis caused by chemicals. b.Peritonitis tertiary. . which carry germs from the outside into the peritoneal cavity. Primary bacterial peritonitis is divided into two. such as appendicitis. . non-tuberculosis pneumonia an Tonsillitis. c. can magnify the effect of aerobic bacteria causing the infection. Bakterii anaerobes. perforation of the intestine so that the feces out of the colon.Wound / trauma penetration.Peritonitis primary bacterial .Complications of the inflammatory process intra-abdominal organs. Germs can be derived from: . especially Bacteroides species.5. a single organism will not cause a fatal peritonitis. immunosuppression. for example: . In general. namely: 1.II. Coli. usually E.Perforation of the organs in the abdomen. chronic renal failure.Non specific: for example.Peritonitis acute bacterial secondary (supurativa) Peritonitis which follows an acute infection or gastrointestinal perforation tractusi or urinary tract.
Granulomatous peritonitis ..Talc peritonitis . d. such sepertii bile. pancreatic lymph.Aseptic / sterile peritonitis .Peritonitis Other forms of peritonitis: . and urine. lymph gastric. Peritonitis is caused by direct irritants.Hiperlipidemik peritonitis .Peritonitis caused by fungi -Peritonitis source of the bacteria that can not be found.
The clinical features depend on the extent of peritonitis.3 Chronic bacterial peritonitis (tuberculous) gives an overview of the clinical presence of night sweats. the pain at first because the main cause. or the public. septic. Stimulation peritonium defans cause tenderness and muscular. or straining.a sign stimulus peritoneum. fever. abdominal distension. Lots of pain if the pain is driven as palpation. abdominal tenderness and rigidity of the local. and the patient was lethargic and syok. pain and loose bowel press decreased or disappeared. In other situations (eg.1 This stimulation causes pain on any movement that causes a shift in the peritoneum peritoneum. Peritonitis can be local. Pain is a subjective form of pain with movement such as walking.1. weight loss. weakness.CHAPTER III CLINICAL DIAGNOSIS III. or tests lainnya. hypotension. and classical bowel weakened or disappeared . psoas tests. the pain being spread throughout the abdomen.CLINICAL The presence of blood or fluid in the peritoneum cavity will give a sign . vomiting. patients usually exhibit other signs and symptoms are nausea. spread. tenderness loose. and then gradually spread from the focus of infection.. laboratory and X-Ray. shock (hypovolemic. severe peritonitis and types of organisms responsible. and in patients with perforation (eg perforated ulcer). and neurogenic). DIAGNOSIS Diagnosis of peritonitis can be enforced by the clinical. and abdominal distention. Clinical features that are common in the presence of primary bacterial peritonitis. breathing. In addition to pain. Decreased bowel peristalsis is lost due to temporary paralysis usus. the patient's body temperature will rise and occurs tachycardia. 1. liver dullness may disappear due to the free air under the diaphragm. While the clinical picture in secondary bacterial peritonitis is the existence of acute abdominal pain. Clinical features for non bacterial peritonitis with acute bacterial peritonitis. severe. diffuse or general. appendicitis). moderate granulomatous peritonitis . When bacterial peritonitis has occurred. Pain is a sudden. fever. coughing. abdominal pain.
Of water fluid level can be expected passage of intestinal disorders. thickening dnding intestine. if possible.2 Radiological Radiological examination is the investigation for consideration in estimating a patient with an acute abdomen. 3. Free air can be seen in cases of perforation. namely: 1. the rays of the vertical projection of anteroposterior (AP). to see the fluid level and the possibility of bowel perforation. Need to set the size of the tape and the film size 35 x 43 cm. X-Ray Ileus is a discovery that is not typical of peritonitis.laboratory test In laboratory tests found the lekositosis. In tuberculosa peritonitis peritoneal fluid contains a lot of protein (more than 3 gram/100 ml) and many lymphocytes.Skewed to the left (left lateral decubitus = LLD). AP projection.showed clinical severe abdominal pain.LLD. In plain abdominal peritonitis done three positions. Shooting should be made using the film cassette that can cover the entire abdomen and its walls.Sleep. such as fish spines picture (Herring bone appearance). with a horizontal beam. When water is short-fluid level layout means there ileus . with a horizontal beam projection AP. if the cause is a disturbance passage intestine (ileus) obstructive then on plain abdominal radiological 3 positions available are: 1.Or half sitting or standing. presence or absence of propagation.3 Prior to the peritonitis. 2.Backs (supine). preperitonial fat. and is the basis of culture results obtained before diagnosis. identified with the culture of the tubercle bacillus. to see the distribution of the intestine. small intestine and large intestine dilated. b. increased hematocrit and metabolic acidosis. Picture obtained by the dilation of intestinal obstruction in the proximal region. III. fever and signs of peritonitis who turned up 2 weeks after surgery. Peritoneal biopsy percutaneous or laparoscopic tuberculomas show characteristic granulomas. 2. c.
short (small intestine) and long . Radiological obtained the water fluid level and step ladder appearance. the main radiological signs are: 1. 3. psoas line disappeared. got free water peritonial intra abdominal highest.high.term (colon) due to colon lumen diameter wider than the small intestine. and blurring the abdominal cavity. On the allegation whether due to peptic ulcer perforation. where a thorough bowel dilation that sometimes . preperitonial fat and psoas line disappears. . .Half sitting or standing.Intestinal general. obtained preperitonial fat disappears. If prolonged ileus obstructive ileus can be paralitik.2 In the case of peritonitis due to bleeding. and herring bone appearance. Picture will be clearer in the USG (ultrasonography) . It is located between the heart of the abdominal wall or the pelvis to the abdominal wall. 3. The picture obtained is the infra-diaphragmatic free air and water fluid level. the images are not clear on plain abdomen.LLD.sometimes difficult to distinguish between hugely dilated intestinum tenue or intestinum crassum. 2. So radiological in obstructive ileus is a partial bowel distension. ruptured appendix or for any other reason. moderate if the long . While in paralytic ileus radiological obtained as follows: . free water obtained subdiafragma crescent (semilunair shadow). So radiological peritonitis is a vagueness in the abdominal cavity.Lie. Peritonitis due to perforation of the radiological picture can be seen on plain abdominal examination 3 positions.air fluid level .Herring bone appearance The difference with obstructive ileus: intestinal dilation fluid thoroughly so the water level was short .term possibility of interference in the colon.Sitting or standing. air fluid levels. and the presence of free air or intra subdiafragma peritoneal.
karena pipa drain itu dengan segera akan terisolasi/terpisah dari cavum peritoneum.) or other inflammatory causes. Urine output of central venous pressure. etc. Agar tidak terjadi penyebaran infeksi ketempat yang tidak terkontaminasi maka dapat diberikan antibiotika ( misal sefalosporin ) atau antiseptik (misal povidon iodine) pada cairan irigasi.3 Drainase (pengaliran) pada peritonitis umum tidak dianjurkan. karena tindakan ini akan dapat menyebabkan bakteria menyebar ketempat lain. because bacteremia will develop during the operation. Returns intravascular volume improve tissue perfusion and delivery of oxygen. or a perforated viscus mereseksi.11 Disposal of septic focus or other inflammatory performed by laparotomy surgery. Broad-spectrum antibiotics are given empirically. appropriate antibiotics. dan dapat menjadi tempat masuk bagi kontaminan eksogen. gastrointestinal decompression by nasogastric suction and intestinal disposal of septic focus (appendix.III. Must be available a sufficient dose during surgery. If localized peritonitis.pain relief measures. mengeksklusi.THERAPY The general principle is replacement therapy lost fluids and electrolytes intravenously performed. 2. and then changed its kind after culture results come out. 11th Lavase peritoneum performed on the diffuse peritonitis. Antibiotic selection based on which organisms are suspected to be the cause. Broad-spectrum antibiotics are also additional surgical drainage. . which is using crystalloid solution (saline). In general. Antibiotic therapy should be administered as soon as the diagnosis of bacterial peritonitis was made. a continuous peritoneal contamination can be prevented by closing. and defense mechanisms. an incision above the intended sites of inflammation. if possible drain the pus out and act. nutrients. Incision is selected vertical incision middle underlined that generate access to the entire abdomen and easily opened and closed. Surgery technique used to control contamination depends on the location and nature of pathologic gastrointestinal tract. Great resuscitation with isotonic saline solution is important. and blood pressure should be monitored to assess the adequacy of resuscitation. Drainase berguna pada keadaan dimana terjadi kontaminasi yang terusmenerus (misal fistula) dan diindikasikan untuk peritonitis terlokalisasi yang tidak dapat direseksi.3. Bila peritonitisnya terlokalisasi. 5. sebaiknya tidak dilakukan lavase peritoneum.
. etc.III. KOMPLIKASI Complication can occur in acute secondary bacterial peritonitis. septicemia and septic syok. salpingitis.6. : a.. Intra abdominal sepsis that can not be controlled with multi-system failure residua intraperitoneal portal pyemia abcess. cholecystitis. gastroenteritis. ruptured ectopic pregnancy.. where complication can be divided into early and advanced complication. pancreatitis.DIFFERENTIAL DIAGNOSIS The differential diagnosis of peritonitis is appendicitis.5. Advanced complication intestinal obstruction III.(hepatic absess) b. while the general prognosis of peritonitis is lethal due to virulen of organism.Prognosis The prognosis for peritonitis is both local and lightweight is fine. hipovolemik shock. III.4.
pelvic inflammatory disease in women who are still active in sexual activity. Formed pockets of pus (abscess) among fibrinous adhesions. The cause of peritonitis include: the spread of infection from an infected abdominal organs. which stick together with the surrounding surface so as to limit the infection. clear membrane covering the abdominal organs and the abdominal wall.CHAPTER IV CONCLUSION Peritonitis is inflammation of the peritoneum which is wrapping the viscera in the abdominal cavity. The peritoneum is a thin. b) c) Antibiotic therapy plays a very important role in the treatment of puerperal infection. The attachment usually disappears when the infection disappear. Patofisologi peritoneum peritonitis was the initial reaction to bacterial invasion is the release of fibrinous exudate. . infection of the uterus and fallopian tubes. d) Surgery include infection of the material and correct the cause. 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. abnormal liver or heart failure. The general principles of therapy in peritonitis are: Replacement of lost fluids and electrolytes made intravenously. but it can be settled as fibrinous bands. Peritonitis are localized only in the pelvic cavity called pelvioperitonitis. Analgesic therapy given to treat pain. peritoneal dialysis (treatment fails kidney). peritonitis can occur after a surgery. which later can cause intestinal obstruction. irritation without an infection.
Gastrointestinal Surgery. 5. Textbook of Surgery. . Jakarta 4.Wim de Jong. Supadmi.Silvia A. 2006. 2007.medikastore. and Sudaryat. Pathophysiology Clinical Concepts Disease Processes. Makassar: 2005 6. Aryasa. In: Capita Selekta Gastroenterology Children. ECG. http://www. Jakarta 2. . .Peritonitis.System Gastroenterohepatology lectures. Price.NANDA Nursing Diagnosis 2005-2006 Prima Medika: Jakarta 3.Subanada. Jakarta: CV Sagung Seto . Some Abnormalities Actions Requiring 7.List Pustaka 1.com/med/peritonitis_pyk. 2005.php?dktg=7&UID 200 705. EGC.
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