GASTROINTEST INAL SYSTEM BLOCK

Click to edit Master subtitle style Ronald Chrisbianto Gani 405090223 Faculty of Medicine 2009 Tarumanagara University

CASE 4B
4/19/12

PERITONITIS
4/19/12

PERITONITIS

Inflammation of the peritoneal lining of the abdominal cavity can result from infectious, autoimmune, neoplastic, or chemical processes Primary : the source of infection originates outside the abdomen and seeds the peritoneal cavity via hematogenous, lymphatic or transmural spread
Nelson Textbook of Pediatrics Secondary : arises from abdominal 18th ed

4/19/12

PRIMARY PERITONITIS

Bacterial infection of the peritoneal cavity without demonstrable intraabdominal source Most frequent pathogens are : pneumococci (most frequent), group A streptococci, enterococci, staphylococci, gram-negative enteric bacteria. Mostly occur before 6yr age
4/19/12

M. Tuberculosis and M.bovis are rare

Nelson Textbook of Pediatrics 18th ed

CLINICAL MANIFESTATION

Fever Abdominal Pain Vomiting and diarrhea toxic appearance Hypotension and tachycardia Rapid RR Rebound tenderness and rigidity
Nelson Textbook Hypoactive / absence of bowel of Pediatrics 18th ed

4/19/12

DIAGNOSIS

Peripheral leukocytosis,predominance of PMN Patient with nephrotic syndrome : proteinuria, low serum albumin increased risk of preitonitis Roentgen : dilatation of large and small intestines, with increased separation of loops secondary to bowel wall thickening
Nelson Textbook of CT-Scan, laparoscopy, laparotomyPediatrics 18th ed

4/19/12

TREATMENT

Parenteral cefotaxime and aminoglycoside started promptly, subsequent changes according to sensitivity testing Therapy should be continued for 1014 days Surgical intervention if indicated
Nelson Textbook of Pediatrics 18th ed

4/19/12

ACUTE SECONDARY PERITONITIS

Mostly due entry of enteric bacteria into the peritoneal cavity through a necrotic defect in the wall of the intestine Most commonly follows perforation of appendix In neonatal : mostly complication of necrotizing enterocolitis, maybe associated with meconium ileus, or Nelson Textbook of Pediatrics 4/19/12 spotaneous rupture 18th ed

CLINICAL MANIFESTATION

Fever (>= 39.5 C) Diffuse abdominal pain Nausea Vomiting Rebound tenderness and rigidity Decreased / absence of bowel sounds Toxic appearance, irritability, Nelson Textbook of Pediatrics 4/19/12
18th ed

TREATMENT

Aggresive fluid resuscitation and support of cardiovascular function Surgical intervention Antibiotics, ampicillin, gentamicin, clindamicin for lower GI tract infection Catheter related peritonitis, cefazolin + ceftazidime, vancomycin/ciprofloxacin Textbook of Pediatrics Nelson
18th ed

4/19/12