surgical procedures and management

Apr 15th, 2015
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Peritonitis and intra abdominalabscessesAnatomy of peritoneum Single layer of mesothelial cells The largest and most complex serous membrane in thebody Closed sac except at the fimbriated ends of fallopian tubes Visceral and parietal layers Surface area is 2m2 50mls of peritoneal fluidDefinition inflammation of the peritoneum Localized generalized Increased exudation of peritoneal fluidClassification of peritonitis Primary peritonitis - spontaneous Secondary peritonitisPrimary peritonitis 1% of cases In association with immunosuppression in adults May also occur in young girls Usually monobacterial Common organisms are haemolytic streptococci,Staphylococcus aureus, Escherichia coli and Klebsiella,Secondary peritonitis Acute suppurative peritonitis perforation (e.g. peptic ulcer, appendix) Infection (e.g. appendix abscess, pyosalpinx) Ischaemia (volvulus, mesenteric ischaemia or strangulated hernia) Chemical peritonitis Granulomatous peritonitis (Powdered surgical gloves,TB and Candida)Secondary peritonitisbacteriologyTypeOrganismPercentageEscherichia coli60%Enterobacter/Klebsiella26%Proteus22%Pseudomonas8%Streptococci28%Enterococci17%Staphylococci7%Bacteroides72%Eubacteria24%Clostridia17%Peptostreptococci14%Peptococci11%Candida2%AerobicGram negativeGram positiveAnaerobicFungiPathophysio

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