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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.
Fascia that covered the walls of the intestine.CHAPTER II THEORY and DISCUSSION II. At the time perkambangan and growth. dorsal and ventral colon closer to each other. called the lamina visceralis (tunica serosa). Thus in both ventral and dorsal colon there is a duplikatura.2 viscera in the cavity.DEFINITION Peritonitis is inflammation of the peritoneum which is wrapping perut. are united on the edge kaudalnya. Ventrikulus high mesentery called mesogastrium ventrale and mesogastrium dorsale. In between the two cavities are entoderm which is enteron wall. 2. Gazette visceralis lamina connecting the right and left parietal lamina sticking together and forming a duplex sheet called duplikatura. Second cavity mesoderm.Fascia visceralis and parietal lamina. which still exist. the mesoderm is the wall of a cavity that is coelom. Lamina connecting 3.1. Duplikatura connects the intestine with walls of ventral and dorsal abdominal wall and can be seen as a tool hanger intestines called the mesentery. namely: 1. At the beginning.Fascia that lines the abdominal wall is called the parietal lamina. The peritoneum is the lamina lateral mesoderm that remain epithelial. Sheets left and right ventrale mesentery. Mesentery is divided into the mesentery and mesenteric ventrale dorsale. ventriculus and intestinal . Peritonitis is an inflammatory or suppurative response of the peritoneum caused by chemical irritation or bacterial invasion. so that the mesoderm then becomes peritoneum. Ventrale mesentery contained in the next caudal pars superior duodeni then disappeared. Enteron abdominal region into the intestine. Peritoneum is divided into three layers.
a fold of peritoneum due to the artery leading to the end of the processus vermiformis.playback. The transverse colon is intraperitoneal and have mounting tool called the transverse mesocolon. Processus vermiformis located intraperitoneally with a hanger mesentery. cecum lies intraperitoneal due at the beginning of a bulge the walls of the intestines and does not have the tools. 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. . thus: The duodenum is retroperitoneal. Colon sigmoideum located intraperitoneally with a mesosigmoideum. In many places. Cavity called the cavum peritonei. After ductus omphaloentericus disappears. called intraperitoneal located. Colon ascendens and colon descendens located retroperitoneal. Sepulcher intestine due to intestinal turned to the right by 270 ° with the axis ductus omphaloentericus and a. As a result of this attachment. and is now the so-called retroperitoneal dorsal peritoneum. not all the happening places of attachment. viscerale peritoneal adhesions in the peritoneum or mesentery parietale not perfect. superior mesenterica respectively in the ventral wall and the dorsal abdominal wall. In places viscerale peritoneum and mesentery dorsale approach dorsale peritoneum. He is actually a continuation of the cecum. Thus there are at flexura duodenojejenalis plica superior duodenal recess duodenal limit superior and limit inferior plica duodenal duodenal resesus inferior. resulting in the notches between the colon (covered by peritoneum viscerale) and peritoneal parietale or between the mesentery and peritoneal parietale restricted folds. it falls down sepulcher intestine and mesentery dorsale closer together parietale peritoneum. Enteron gut or in a place associated with the umbilicus and saccus vitellinus. Jejenum and ileum located intraperitoneally with a hanger mesentery. Because sepulcher intestine rotates. there are parts that do not have bowel tools hanger again. The folds can also terjadfi because it runs the blood vessels. These relationships form a tube called the ductus omphaloentericus. adhesions occur. Intestinal growing faster than the cavity so that the intestine had occurred twistingsepulcher sepulcher. However. The parts that still have the tool hanger is located inside the wall cavity formed by the peritoneum parietale.
Terkaudal close attachment part that runs trasversal transverse mesocolon. menyilangi adjacent dorsal pars superior . Lympha vessels. so that the cardia and pylorus move to the left to the right. entered in the fossa sagittalis sinistra hepatis and ends on ramus sinistra portae vein.In the colon there descendens paracolici recess. Caudal section also occurs mesogastrium dorsale attachment to the transverse mesocolon and omentum called magi. Lesser omentum attached to the fossa sagittalis sinistra dorsokranial and surrounds part portae hepatis. In the liver ventrale mesogastrium formed and evolved. Thus mesogastrium dorsale attachment for an arc from left to right cranial caudal. walk through the ligament to kaudomedial. Ventriculus rotate the longitudinal axis. On the left runs a. Ductus choledochus. Autonomic nerve fibers. Choledocus duct formed by the duct and ductus hepaticus communis cysticus. Pockets formed by him called omentalis stock. Mesogastrium ventrale attached to the ventral abdominal wall parietale peritoneum and the diaphragm. Ventriculus because they rotate. Ligamentum teres hepatis sinistra the rest of the umbilical vein. causing the building called epiploicae Appendices. In the colon there sigmoideum intersigmoideum recess between the peritoneum and mesosigmoideum parietale. portae. hepatica propria in the second dorsal side of this building in the middle of running v. extending from the umbilicus to the liver in the free edge of the ligament falciforme hepatis. most mesogastrium dorsale approach perietale peritoneum and grow attached. Then ventriculus play against the sagittal axis. In the free edge of the lesser omentum or ligament hepatoduodenale are: Vena portae. thus curvatura major in minor curvatura the left and the right. Liver evolved into caudal to the edge of the lesser omentum mesogastrium called or ligament hepatogastricum the next caudal edge freely called hepatoduodenale ligament. Stratum circulare coli folds and unfolds so happens plica semilunaris. Arteria hepatica propria. Peritoneum covering the colon folds and unfolds out filled with fat. Falciforme ligament attached to the boundary between the lobe lobe dexter and sinister.
Part bursae omentalis terkranial called bursae omentalis superior recess. Because most mesogastrium dorsale mesoduodenum and grow attached to the peritoneum parietale. Magi omentum is divided in two by a ligament precholienale lien. but still within the cauda pancreatis greater amentum. Because the lien grow. 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. The two sheets of folds that grow attached caudal section. ligament gastrosplenic section between lien and ventriculus. In the mesentery and duodenum (mesoduodenum) and mesogastrium dorsale going and growing pancreas.hepatoduodenale Caudal section by pars superior duodeni Dorsal section by parietale peritoneum covering the inferior vena cava. the lien and the peritoneum covering the diaphragm parietale. Because there was a change in the location of the stock omentalis ventriculus.duodeni up in the sulcus between the pars descendens duodeni and caput pancreatis duodeni major tributaries of the papillae. caput and corpus-located pancreatis retroperitoneal. especially to the left. The part that does not grow is a continuation omentalis called bursae bursae omentalis inferior recess. while the sheet is attached to the left from the hilum surrounded lien. second right sheet ligamentumtidak until the lien attached. Into the hole called the foramen epiploicum omentalis stock (Winslowi) is limited: Cranial section by caudate processus Ventral section by lig. 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. .
ascending colon and descenden. consisting of layers of skin and sub kutis kuitis. Thus incision or suturing of the intestine can be done without perceived by the patient. Fluid and electrolyte small can move both directions. slick and slippery due to increased peritoneal fluid mengeluiarkan bit. Obliquus external abdominis. The peritoneum is a smooth easy movement of intra peritoneal tools to one another. and at the bottom of the pelvis. Viserale peritoneum that surrounds the abdominal organs are innervated by the autonomic nervous system and is not sensitive to palpation or cutting. pancreas. and parietal parts that lines the abdominal wall and fascia associated with muskularis. 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.2. gallbladder fellea. However. pemuntaran ventriculus and intestine sepulcher going in the other direction. and appendix (intraperitoneum). and patients can pinpoint the location of pain. ileum.ANATOMY Abdominal wall containing structures musculo-aponeurosis complex. The transverse . sub-cutaneous fat and superficial facies (facies skarpa). so that pain can arise due to the stimuli in the form of palpation. The back of the structure is attached to the upper spine to the ribs. then there will be pain. that covers the intestines and mesentery. The state is called situs inversus. Molecules larger diaphragm cleared into mesothelium and lymphatic through stomata kecil. 4 Parietale peritoneum innervated by peripheral nerves. The abdominal wall consists of various layers. Pain is felt like a stabbing or slashed. Total peritoneal surface area of about 2 meters. or excessive contraction of muscles causes ischemia eg colic or inflammation such as appendicitis. spleen. cecum. kidney and ureter (retroperitoneum ). As a result. jejenum.5 Organs located in the peritoneal cavity of gastric. then the third abdominal wall muscles m. and its activity is consistent with a semipermeable membrane. duodenum.7 II. or inflammatory processes. 6. The peritoneum is a single layer of cells on the basis fibroelastik mesoepitelial. the tools should be located on the right side to the left or vice versa. Divided into sections visceral. when performed organ pull or strain. Sometimes. m. Thus.Plain coated peritoneal mesothelium. the peritoneum can be likened to the stratum synoviale in joints. transverse colon. liver. pressure. sigmoid colon. from outside to inside. Obliquus internus abdominis and m.
The integrity of layers musculo-aponeurosis abdominal wall is very important to prevent congenital hernia occurs.Bakterial: Bacteroides. perforated peptic ulcers.6 Abdominal wall to form the abdominal cavity that protects the contents of the abdominal cavity. Intercostalis VI .3. The attachment usually disappears when the infection disappear. Wealth vascularization allows horizontal and vertical abdominal incision without causing interference perdarahan. KlebsiellaEnterobacter group. and finally layered preperitonium and peritoneum.PATOFISOLOGI The initial reaction to invasion by bacteria peritoneum is a discharge of fibrinous exudate. and external pudendal a. streptococcus.abdominis. superior epigastric. From there a caudal. a. sircumfleksa superficial. but it can persist as fibrous bands. lumbar I. and pancreas. acquired. Obstructive ileus and bleeding due to perforation of a hollow organ due to trauma abdomen. Pockets of pus (abscess) formed between fibrinous adhesions. 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. Mycobacterium Tuberculosa. Another function of the abdominal wall was breathing well on the process of urination and defecation with elevated intra-abdominal pressure. preperitonial fat and peritoneum. E. foreign body (talc.Etiology Peritonitis can be caused by abnormalities in the abdomen such as inflammation and perforation penyulitnya appendicitis.XII and n. coli. urine. inferior epigastric. iliaca a.3. abdominal typhoid perforation. b. From kraniodorsal acquired bleeding from aa branch. The release of various . or iatrogenic. bile. Pneumococus.2 a.6 II.XII and a.4. 2. blood.thorakalis VI . Abdominal wall bleeding from several directions.6 Innervation of the abdominal wall in segmental dipersyarafi by n. Cause inflammation and fluid accumulation due to capillary membrane leak. which later can lead to intestinal obstuksi.9 II. which stick together with the surrounding surface so as to limit the infection. If the fluid deficit is not corrected quickly and aggressively. it can lead to cell death.Kimiawi: sap stomach. the fascia transversalis. Proteus. flour).
shock. it can arise generalized peritonitis. If infected material is widespread on the surface of the peritoneum or when the infection spreads. on stangulasi ileus accompanied pinched blood vessel obstruction causing ischemia. Ileus Ileus may be as simple as intestinal obstruction that is not accompanied pinched blood vessels and can be total or partial. the input that does not exist. 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. With the development of generalized peritonitis. Because the body tries to compensate by way of retention of fluid and electrolytes by the kidneys. cough. waste products also accumulate. such as interleukins. further increasing intra abdominal pressures. resulting in dehydration. Lost fluids and electrolytes into the intestinal lumen. 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. can start hiperinflamatorius response. Edema caused by capillary permeability organs are rising. Adhesions can form between the intestine arches that stretch and can interfere with the recovery of bowel movement and cause intestinal obstruction.mediators. ileal perforation in typhoid fever usually occurs in patients who have a fever for more than 2 weeks accompanied by headache. reduced peristaltic activity to arise paralytic ileus. and vomiting. making a full effort into breathing difficult and causing decreased perfusion. so as to bring to the further development of the failure of many organs. Trapping fluid in peritoneal cavity and intestinal lumen. Typhi that enter the human body through the mouth from contaminated food and water. circulatory disorders and oliguria. and malaise followed by . 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. Some germs destroyed by stomach acid. but it soon failed so happens hypovolemia. Tachycardia initially increase cardiac output. Hypovolemia increases with an increase in temperature. Abdominal typhus is an acute infectious intestinal disease caused by the bacteria S. 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. intestine then becomes Atoni and stretch. 5 The organs in the peritoneal cavity including abdominal wall had edema.
Then spread throughout the abdomen causes pain all over the abdomen in early perforation. the longer the mucus is more and more. causing perforation and peritonitis eventually lead to both local and general. 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. but the elasticity of the wall of the appendix has limitations that led to increased intraluminal pressure and impede lymph flow resulting in edema. diapedesis bacteria. and the general state of decline due to toksemia.7 In both abdominal trauma and abdominal penetrating trauma blunt abdominal trauma can lead to peritonitis. ranging from the nature of gastric chemistry until the colon that contains feces. sometimes called phase phase chemical peritonitis. Obstruction causes mucus produced mucosal dam experience. Patients who experience severe pain perforation looks like being stabbed in the stomach. Peritonial stimuli arising in accordance with the contents of the hollow organs. sepsis when the intra peritonial hollow organs. 7 . When perforation occurs at the top. foreign body. the pain in the shoulder show excitability peritonium be mengenceran stimulates acid salt. this will reduce the complaints for a while until it happens peritonitis bakteria. fekalit.abdominal pain. mucosal ulceration. and bile or pancreatic enzymes. defans muscular.1. tenderness.1 In appendicitis usually is usually caused by a blockage of the lumen of the appendix by hyperplasia of lymphoid follicles. no early symptoms because microorganisms need time to breed new after 24 hours of onset of symptoms of acute abdomen because stimulation peritonium. stricture due to fibrosis and neoplasms. no bacterial infection. Chemical stimulus onset fastest and slowest feces. especially felt in the epigastric region due to stimulation of peritoneum by stomach acid. 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. Perforation of the stomach and duodenum front causing acute peritonitis. This pain arises suddenly.
and splenectomy. Besides an extensive and long-contamination of bacteria also can aggravate peritonitis. The reason is monomikrobial.CLASSIFICATION Based on the pathogenesis of peritonitis can be classified as follows: a. Synergism of multiple organisms can aggravate this infection.Wound / trauma penetration. such as appendicitis. High-risk groups are patients with nephrotic syndrome. perforation of the intestine so that the feces out of the colon. Peritonitis is bacterial contamination haematogenously the peritoneal cavity and found no focus of infection in the abdomen. for example: . In general. can magnify the effect of aerobic bacteria causing the infection. Bakterii anaerobes.Peritonitis primary bacterial . . Sreptococus or Pneumococus.Non specific: for example.Complications of the inflammatory process intra-abdominal organs.5. Primary bacterial peritonitis is divided into two.Perforation of the organs in the abdomen. which carry germs from the outside into the peritoneal cavity. Risk factors that contribute to this is the presence of malnutrition peritonitis. a single organism will not cause a fatal peritonitis. immunosuppression. namely: 1. and hepatic cirrhosis with ascites. usually E. b.Peritonitis tertiary. intraabdominal malignancy. c. especially Bacteroides species. .II. Coli. chronic renal failure. systemic lupus erythematosus.Spesifik: eg Tuberculosis 2. Germs can be derived from: .Peritonitis acute bacterial secondary (supurativa) Peritonitis which follows an acute infection or gastrointestinal perforation tractusi or urinary tract. non-tuberculosis pneumonia an Tonsillitis. such as peritonitis caused by chemicals.
and urine. lymph gastric.. d. such sepertii bile. pancreatic lymph.Talc peritonitis . Peritonitis is caused by direct irritants.Hiperlipidemik peritonitis .Peritonitis caused by fungi -Peritonitis source of the bacteria that can not be found.Peritonitis Other forms of peritonitis: .Granulomatous peritonitis .Aseptic / sterile peritonitis .
abdominal distension.1. or tests lainnya. the pain being spread throughout the abdomen. psoas tests. In other situations (eg.3 Chronic bacterial peritonitis (tuberculous) gives an overview of the clinical presence of night sweats. patients usually exhibit other signs and symptoms are nausea.a sign stimulus peritoneum. While the clinical picture in secondary bacterial peritonitis is the existence of acute abdominal pain. and classical bowel weakened or disappeared . shock (hypovolemic. When bacterial peritonitis has occurred. coughing. In addition to pain. Stimulation peritonium defans cause tenderness and muscular. the patient's body temperature will rise and occurs tachycardia. The clinical features depend on the extent of peritonitis.CLINICAL The presence of blood or fluid in the peritoneum cavity will give a sign . Peritonitis can be local. or the public. liver dullness may disappear due to the free air under the diaphragm. and neurogenic). abdominal tenderness and rigidity of the local. diffuse or general. and in patients with perforation (eg perforated ulcer). tenderness loose. and then gradually spread from the focus of infection. appendicitis). Lots of pain if the pain is driven as palpation. Pain is a sudden. hypotension. spread. fever. or straining. abdominal pain. Clinical features for non bacterial peritonitis with acute bacterial peritonitis.. vomiting. severe peritonitis and types of organisms responsible. the pain at first because the main cause. laboratory and X-Ray.1 This stimulation causes pain on any movement that causes a shift in the peritoneum peritoneum.CHAPTER III CLINICAL DIAGNOSIS III. septic. pain and loose bowel press decreased or disappeared. moderate granulomatous peritonitis . weakness. fever. weight loss. Clinical features that are common in the presence of primary bacterial peritonitis. Decreased bowel peristalsis is lost due to temporary paralysis usus. and abdominal distention. and the patient was lethargic and syok. breathing. DIAGNOSIS Diagnosis of peritonitis can be enforced by the clinical. Pain is a subjective form of pain with movement such as walking. severe. 1.
the rays of the vertical projection of anteroposterior (AP). such as fish spines picture (Herring bone appearance). III.LLD.showed clinical severe abdominal pain. c. 2. thickening dnding intestine. b.Backs (supine). namely: 1. Peritoneal biopsy percutaneous or laparoscopic tuberculomas show characteristic granulomas. Need to set the size of the tape and the film size 35 x 43 cm.Skewed to the left (left lateral decubitus = LLD).2 Radiological Radiological examination is the investigation for consideration in estimating a patient with an acute abdomen. identified with the culture of the tubercle bacillus. Free air can be seen in cases of perforation. Picture obtained by the dilation of intestinal obstruction in the proximal region. When water is short-fluid level layout means there ileus . with a horizontal beam. to see the distribution of the intestine. small intestine and large intestine dilated. In tuberculosa peritonitis peritoneal fluid contains a lot of protein (more than 3 gram/100 ml) and many lymphocytes.laboratory test In laboratory tests found the lekositosis. fever and signs of peritonitis who turned up 2 weeks after surgery. to see the fluid level and the possibility of bowel perforation. Of water fluid level can be expected passage of intestinal disorders. Shooting should be made using the film cassette that can cover the entire abdomen and its walls. In plain abdominal peritonitis done three positions. if the cause is a disturbance passage intestine (ileus) obstructive then on plain abdominal radiological 3 positions available are: 1. presence or absence of propagation.3 Prior to the peritonitis. and is the basis of culture results obtained before diagnosis. 3. AP projection.Or half sitting or standing. X-Ray Ileus is a discovery that is not typical of peritonitis. preperitonial fat. 2. with a horizontal beam projection AP. increased hematocrit and metabolic acidosis. if possible.Sleep.
moderate if the long . Radiological obtained the water fluid level and step ladder appearance. 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. preperitonial fat and psoas line disappears.Sitting or standing.term possibility of interference in the colon.sometimes difficult to distinguish between hugely dilated intestinum tenue or intestinum crassum.Lie. psoas line disappeared. 3. Picture will be clearer in the USG (ultrasonography) . the images are not clear on plain abdomen. 3. If prolonged ileus obstructive ileus can be paralitik. free water obtained subdiafragma crescent (semilunair shadow).LLD.high.Intestinal general. .2 In the case of peritonitis due to bleeding.short (small intestine) and long . and herring bone appearance. and blurring the abdominal cavity. got free water peritonial intra abdominal highest. the main radiological signs are: 1. air fluid levels.air fluid level . and the presence of free air or intra subdiafragma peritoneal. So radiological peritonitis is a vagueness in the abdominal cavity. where a thorough bowel dilation that sometimes . . While in paralytic ileus radiological obtained as follows: . It is located between the heart of the abdominal wall or the pelvis to the abdominal wall. ruptured appendix or for any other reason. 2. obtained preperitonial fat disappears. On the allegation whether due to peptic ulcer perforation.term (colon) due to colon lumen diameter wider than the small intestine. So radiological in obstructive ileus is a partial bowel distension.Herring bone appearance The difference with obstructive ileus: intestinal dilation fluid thoroughly so the water level was short .Half sitting or standing.
) or other inflammatory causes. 5. If localized peritonitis. 2. Antibiotic selection based on which organisms are suspected to be the cause.11 Disposal of septic focus or other inflammatory performed by laparotomy surgery. appropriate antibiotics. Agar tidak terjadi penyebaran infeksi ketempat yang tidak terkontaminasi maka dapat diberikan antibiotika ( misal sefalosporin ) atau antiseptik (misal povidon iodine) pada cairan irigasi. Urine output of central venous pressure. and then changed its kind after culture results come out. nutrients. if possible drain the pus out and act. or a perforated viscus mereseksi.pain relief measures. karena tindakan ini akan dapat menyebabkan bakteria menyebar ketempat lain.3. Surgery technique used to control contamination depends on the location and nature of pathologic gastrointestinal tract.THERAPY The general principle is replacement therapy lost fluids and electrolytes intravenously performed. etc.3 Drainase (pengaliran) pada peritonitis umum tidak dianjurkan. an incision above the intended sites of inflammation. because bacteremia will develop during the operation. mengeksklusi. Antibiotic therapy should be administered as soon as the diagnosis of bacterial peritonitis was made. karena pipa drain itu dengan segera akan terisolasi/terpisah dari cavum peritoneum. which is using crystalloid solution (saline). gastrointestinal decompression by nasogastric suction and intestinal disposal of septic focus (appendix. and defense mechanisms. Bila peritonitisnya terlokalisasi. Broad-spectrum antibiotics are given empirically. and blood pressure should be monitored to assess the adequacy of resuscitation. Great resuscitation with isotonic saline solution is important. sebaiknya tidak dilakukan lavase peritoneum. . 11th Lavase peritoneum performed on the diffuse peritonitis. Broad-spectrum antibiotics are also additional surgical drainage. Returns intravascular volume improve tissue perfusion and delivery of oxygen. Incision is selected vertical incision middle underlined that generate access to the entire abdomen and easily opened and closed. In general. dan dapat menjadi tempat masuk bagi kontaminan eksogen. a continuous peritoneal contamination can be prevented by closing. Must be available a sufficient dose during surgery.III. Drainase berguna pada keadaan dimana terjadi kontaminasi yang terusmenerus (misal fistula) dan diindikasikan untuk peritonitis terlokalisasi yang tidak dapat direseksi.
pancreatitis. where complication can be divided into early and advanced complication. while the general prognosis of peritonitis is lethal due to virulen of organism. salpingitis.6. . gastroenteritis. Intra abdominal sepsis that can not be controlled with multi-system failure residua intraperitoneal portal pyemia abcess. ruptured ectopic pregnancy. KOMPLIKASI Complication can occur in acute secondary bacterial peritonitis. III..Prognosis The prognosis for peritonitis is both local and lightweight is fine. : a.5.DIFFERENTIAL DIAGNOSIS The differential diagnosis of peritonitis is appendicitis. Advanced complication intestinal obstruction III. etc. cholecystitis.III. hipovolemik shock.(hepatic absess) b..4. septicemia and septic syok.
Analgesic therapy given to treat pain. d) Surgery include infection of the material and correct the cause. peritoneal dialysis (treatment fails kidney). b) c) Antibiotic therapy plays a very important role in the treatment of puerperal infection. pelvic inflammatory disease in women who are still active in sexual activity. but it can be settled as fibrinous bands. 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.CHAPTER IV CONCLUSION Peritonitis is inflammation of the peritoneum which is wrapping the viscera in the abdominal cavity. irritation without an infection. Formed pockets of pus (abscess) among fibrinous adhesions. The cause of peritonitis include: the spread of infection from an infected abdominal organs. The general principles of therapy in peritonitis are: Replacement of lost fluids and electrolytes made intravenously. . which later can cause intestinal obstruction. which stick together with the surrounding surface so as to limit the infection. The peritoneum is a thin. abnormal liver or heart failure. The attachment usually disappears when the infection disappear. peritonitis can occur after a surgery. Peritonitis are localized only in the pelvic cavity called pelvioperitonitis. infection of the uterus and fallopian tubes. Patofisologi peritoneum peritonitis was the initial reaction to bacterial invasion is the release of fibrinous exudate. clear membrane covering the abdominal organs and the abdominal wall.
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