MindMap Gallery acute suppurative peritonitis
Acute purulent peritonitis is a common surgical acute abdomen, mainly caused by bacterial infection. It has the characteristics of rapid onset, rapid progression, and serious condition.
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acute suppurative peritonitis
acute suppurative peritonitis
Inflammation of the peritoneum and peritoneal cavity caused by factors such as bacterial infection, chemical irritation, or physical injury
Causes and Classification
primary peritonitis
Secondary peritonitis: the most common type of acute purulent peritonitis Escherichia coli is the most common
Pathophysiological process
Inflammation
Hemodynamic changes
local changes in abdomen
Metabolic disorders
clinical manifestations
Abdominal pain: The main symptom is persistent severe abdominal pain
Nausea and vomiting: reflexive, vomiting is gastric contents
Changes in body temperature and pulse: related to the severity of inflammation If the pulse is fast but the body temperature drops, it is one of the signs that the condition is getting worse.
Symptoms of infection and poisoning: chills, high fever, rapid pulse, shallow and rapid breathing, bulkiness, dry mouth
Abdominal compartment syndrome: one of the serious complications
abdominal signs
View: Increased abdominal distension is an important sign of worsening condition
Touch: peritoneal irritation sign, tenderness, rebound tenderness, abdominal muscle tension
Percussion: Positive moving dullness
Listen: Bowel sounds weaken or disappear
Digital rectal examination: the anterior rectal fossa is full and tender
laboratory tests
Blood routine: increased white blood cell count and neutrophil ratio
Abdominal CT: the gold standard for imaging diagnosis of abdominal infection
Diagnostic paracentesis or peritoneal lavage
Processing principles
Implement source control within 24 hours of confirmed abdominal infection
non-surgical treatment
Generally, patients should be placed in a semi-recumbent position, and patients with shock should be placed in a supine or shock position.
Fasting and gastrointestinal decompression
Correct water and electrolyte imbalance
Rational use of antibiotics
Supplemental caloric and nutritional support
Symptomatic treatment such as sedation, analgesia and oxygen inhalation
Percutaneous drainage of abdominal effusion
Surgical treatment
Those who fail to respond to non-surgical treatment after 6 to 8 hours of non-surgical treatment
Severe intra-abdominal primary disease
Severe intra-abdominal inflammation, especially those with shock and ACS
The cause of peritonitis is unclear and has no localized trend
Indications
Postoperative care
Condition observation
Position and activities: Before waking up from general anesthesia after surgery, take a supine position with pillows removed, head tilted to one side
Fasting, gastrointestinal decompression
Fluid rehydration and nutritional support
Abdominal drainage care
Drainage tube: properly secure the drainage tube, clearly label it, and keep it unobstructed
Drainage bag: The drainage bag must be lower than the abdominal drainage port to prevent retrograde infection
Drainage fluid: observe and record the color, properties and amount of drainage fluid
skin care
Indications for extubation
Prevent complications
abdominal abscess
It refers to the localized accumulation of pus in a certain space or part of the abdominal cavity. It is a general term for abscesses in any part of the abdominal cavity below the diaphragm and above the pelvic floor.
subphrenic abscess
clinical manifestations
Fever, initially flaccid fever, then persistent high fever after abscess formation
Gradual onset of fatigue, weakness, night sweats, lack of appetite, weight loss, etc.
Nursing measures
Position: semi-recumbent position
Anti-infective
maintain normal body temperature
Abscess Drainage Care
pelvic abscess
clinical manifestations
During the treatment of acute peritonitis, the body temperature drops and then rises
Digital rectal examination often has positive findings
Nursing measures
semi-recumbent position
Follow the doctor’s instructions and perform physical therapy such as abdominal hot compress and warm water sitz bath.