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04-29-2008, 01:09 PM
m Causes:
1- Inflammed abdominal organ:
- Perforated appendix " commonest".
- Perforated peptic ulcer "2nd common".
- Acute pyogenic cholecystitis.
- Acute salpingitis.

2- Rupture abdominal organ:
- Rupture intestine.
- Rupture diverticulum of the colon.
- Rupture bladder (intraperitoneal).
- Rupture uterus.
- Rupture volvulus sigmoid.
3- Penetrating injury: stab wound.
4- 1ry peritonitis: blood born infection.



m Pathology:
When peritoneal contamination occurs many factors help in localization of infection.
- Anatomical factors:
*Division of the peritoneum into lesser and greater sacs.
* Presence of omentum (policeman of the abdomen)
- Physiological factors:
*Reflex inhibition of peristalsis.
*Chemotaxis property of the omentum direct it to the lesion.
- Pathological factors:
* Fibrinous layer
* Exudation ®dilute toxins.
Also the general resistance of the patient and virulence of the organism play an important role in the progress of peritonitis.
m Clinical Picture:
(I) Symptoms: History of the cause +
a) Pain: Aching pain allover the abdomen. maximum over the cause.
b) Vomiting: Frequent.
c) Fever,according the condition.
d) Constipation.
e) Abdominal distention "In neglected cases".
(II) Signs:
a) Tenderness allover the abdomen.
b) Rigidity.
c) Rebound tenderness.
d) Dehydration & toxemia (Earthy looking).
e) ­ temperature (dropped terminally).
m Investigations:
1- Total leucocytic count:­ but not specific.
2- Plain x-ray "erect position" ® Gas under diaphragm.
3- Ultrasonography: Free fluid (pus) in the peritoneal cavity of localized collection.
mTreatment:
(I) Pre operative measures:
- N/G suction.
- I.V. fluid
- Antibiotics.
(II) Operative measures:
Treatment of the cause e.g. sealing of perforation, or excision of diseased organ (The cause).Then, do peritoneal lavage and put drains.
SOURCE: DR. AYMAN SALEM'S BOOK
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