*PERITONITISDr. IWAN BUDIMAN, sp.BSUBAGIAN BEDAH /RSUD. Sumbawa

*PERITONITIS :Infeksi di rongga abdomen :E/: - Perdarahan- pus- cairan bebas infeksi- feses - infeksi bakter ,TBCusus

*PERITONITIS :Infeksi di rongga abdomen dan inflamasi sbg reaksi di abdomenE/: - Perforasi- imflamatory- Infeksi- Inschemic injury - perdarahan

*Secondary Peritonitis :- Bactirial Contamination, from : - viscera - external (eg. Penetrating injury)Primary Peritonitis- Hemotogenous- Transluminal/direct bacterial invasion of Peritoneal Cavity

*Common Causes of Peritonitis :

SeverityCauseMortality RateMILDAppendicitisPertorated Gastroduodenal ulcersAcute Salpingitis< 10 %MODERATEDiverticulosisNonvascular small bowel pertorationGangrenous CholecystitisMultiple trauma< 20 %SEVERELarge bowel pertorationsIschemic small bowel perforationAcute necrotizing pancreatitisPost operative complication 20-80 %

*DIAGNOSTIC :Simptom( keluhan) dan gejala :* Clinical manafestation : - demam - nyeri dan perut membesar. - MUNTAH HIJAU- flatus(-) , BAB(-)- Age- General Health* Pemeriksaan fisik utk melihat : Adakah riwayat trauma abdomen

** gejala local pada abdomen :- nyeri seluruh abdomen- Tenderness- Distention- Bising usus menghilang- cairan / udara bebas di rongga abdomen

*Gejala sistemik :- Fever- Tachycardia- mual , muntah- Tachypnea- Dehydration- Oliguria- Shock

*Laboratory :- Darah lengkap - Elektrolyte- Blood Clotting- Liver and renal function test- Sample for culture (blood, urine, sputum, peritoneal fluid)

*X. Ray :- BOF- Left lateral decubitus

*TREATMENT:

O P E R A S I ( LAPAROTOMY )

*

*TREATMENT:A. Preoperative Care- intravenous Fluid ( cairan IV)- Antibiotics

B. Operative Management ( Laparotomy)- Control sepsis- Peritoneal lavage ( cuci rongga abdomen)- Peritoneal drainage- Management of abdominal distention

*Post operative Care :- Intensive care monitoring- stabilkan hemodynamic - Antibiotics (10-14 days)

*COMPLICATIONS :Local :- infections dari seluruh usus- Intraperitoneal sepsis- gangguan anatomy usus- Fistula abdomenSystemic :- Uncontrolled sepsis MODS MOF

*TERIMA KASIH