Just For Sharing : Classification of Peritonitis

Syllabus Year 4 Phase 2 (Surgical Diseases)

CLASSIFICATION OF PERITONITIS

1. TYPES:

i - PRIMARY

(Causes are outside the abdominal cavity, mainly refer to haematogenic and lymphogenic. Primary is usually in children)

ii - SECONDARY

(This is the most common type. Causes are inside abdominal cavity, mainly due to intestinal bacteria invasion from digestive tract or biliary tract in case of inflammation & rupture of internal organs.

2. ETIOLOGY:

i - BACTERIAL PERITONITIS

(a) Specific - Intestinal sticks ( 65%) causes bacterial type. Most reason is acute appendicitis & acute cholecystitis which cause Secondary bacterial peritonitis.

(b) Unspecific - cause by microbes with no relation to GIT (eg. TB)

ii - ASEPTIC PERITONITIS

(Usually cause by pancreatonecrosis. The blood, bile, urine presence in the abdominal cavity and after several hours, aseptic contents become infected due to the microbial invasion from GIT. Need to treat a.s.a.p.

3. CURRENT PERITONITIS

i - ACUTE (most common in complication of the abdominal cavity)

ii - SUBACUTE (usually cause by TB)

iii - CHRONIC

4. SEVERITY

i - MODERATE (peritonitis alone without any disorder of other organ)

ii - SEVERE (peritonitis with involvement of 1 organ like liver or lung)

iii - VERY SEVERE (peritonitis with involvement of more than 1 organs)

5. INVOLVEMENT OF PERITONEUM IN INFLAMMATION (by FEDOROV)

i - LOCAL : This is involvement of only 1 region of peritoneum. It can be:

(a) Incapsulated - inflammation of 1 region of peritoneum without restriction

(b) Encapsulated - inflammation of 1 region of peritoneum with restriction like fibrin formation and intraperitoneal adhesions

ii - DISSEMINATED : This is involvement of >1 region of peritoneum. It can be:

(a) Diffuse - inflammation of 2-5 regions of peritoneum

(b) Generalized - inflammation of >5 regions of peritoneum

NB! There are all 9 regions of peritoneum!! Please revise how to draw them all!

6. PARAMETERS OF EXUDATES

i - SEROUS PERITONITIS (initial stage of peritonitis. The exudate is transparent)

ii - HAEMORRHAGIC (Only cause by 2 reasons: Pancreatonecrosis & AIO)

iii - SEROUS-FIBRINOUS (fluid with fibrin)

iv - PURULENT (fluid with pus)

Other forms also possible : Fecal, bile and etc.

7. TIME OF ONSET:

i - INITIAL GRADE ( within 24h)

ii - TOXIC GRADE (24 - 72h)

iii - TERMINAL GRADE (>72h)

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ADDITIONAL RANDOM KNOWLEDGES, THAT YOU MUST KNOW:

What is the peculiarities of URGENT HERNIOPLASTY

(like in strangulated hernia)?

We must not cut the hernial ring, but need to open the hernial sac, fix and check the content!

What is the peculiarities of HERNIOPLASTY by LEINSTEIN?

Use the POLYPROPYLENE mash and must not apply any TENSION

That's all. Good luck. Tawakkal alaAllah.

'Let us forget about exam, but focus on study'