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'

Leia Mais…

Just For Sharing : McBurney's Incision for Appendicectomy

*Sorry this picture's quality is not so good =(

HOW TO DRAW THE INCISION?

1. Draw a single line from UMBILICUS to the RIGHT ANT.SUP. ILIAC SPINE

2. Divide this line (blue in colour) into 3 parts equally.

3. Then, at the point of INFERIOR 1/3 of this line, draw a single line (red in colour) perpendicularly to the blue line.

4. This red line is the McBurney incision line for Appendicectomy.

5. The length of this incision line MUST be 1/3 superior and 2/3 inferior to the blue line that you drew.

6. One more important thing is, this incision line should be PARALLEL to the INGUINAL LIGAMENT!

That's all. Good luck! Tawakkal alaAllah. =)

Leia Mais…

Just For Sharing : Classification of Acute Intestinal Obstruction

Syllibus Year 4 Phase II (Surgical Diseases)

CLASSIFICATION OF ACUTE INTESTINAL OBSTRUCTION (AIO)

1. STAGES :

I - Impairment of passage

II - Disturbance of microcirculation

III - Peritonitis & necrosis

2. ORIGIN:

I - Congenital (eg: Complete atresia of SI, LI, anus & sclerosis)

II - Acquired (eg: Malignant tumour, trauma, bile stones ileus)

3. MECHANISM:

i. Mechanical

a) Obturation

(eg: Tumour, Foreign body, Gall stone)

b) Strangulation

(eg: Irreducible strangulated hernia, volvulus 0r mesentery twist)

Characteristic: Formation of knots or coils of SI loops with each others.

c) Mix

(eg: Invagination, adhesion)

Characteristic: Invagination (proximal part comes to distal part). This invagination is called as intersusception. Usually in children.

In adult, there are usually adhesion.

Causes of adhesion: Trauma of peritoneum, peritonitis, post-op.

Eg. of post-op that causes adhesion:

- Appendicectomy (adhesion at Right Iliac Region)

- Splenectomy (adhesion of Left Hypochondrium)

ii. Dynamic

a) Spastic (eg: Spinal cord trauma, poisonings)

b) Paralytic

(This is typical AIO. Causes: Complication of urgent abdominal diseases, eg: Peritonitis, Pancreatitis, etc.)

4. LEVEL OF OBSTRUCTION

i. High (SI)

ii. Lower (LI)

5. CLINICAL STATES OF PATIENT

i. Acute (eg: adhesion, strangulation)

ii. Chronic (eg: tumour)

6. CONDITION OF INTESTINES

i. Complete obstruction

ii. Partial obstruction

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CONCLUSIONS:

1. There are 3 types of mechanical AIO:

I - Acute Mechanical Obturation IO

II - Acute Mechanical Strangulation IO

III - Acute Mechanical Mix IO

2. There are 2 types of dynamic AIO:

I - Acute Dynamic Spastic IO

II - Acute Dynamic Paralytic IO (typical)

NB!

STRANGULATION - Needs IMMEDIATE SURGERY!

OBTURATION - You have 4 HOURS to OPERATE!

That's all. Good luck. Tawakkal alaAllah =)

Leia Mais…