Septic Peritonitis
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement
CLINICAL REPORT Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement ÃEdwin F. de Zoeten, zBrad A. Pasternak, §Peter Mattei, ÃRobert E. Kramer, and yHoward A. Kader ABSTRACT disease. The first description connecting regional enteritis with Inflammatory bowel disease is a chronic inflammatory disorder of the perianal disease was by Bissell et al in 1934 (2), and since that time gastrointestinal tract that includes both Crohn disease (CD) and ulcerative perianal disease has become a recognized entity and an important colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss consideration in the diagnosis and treatment of CD. Perianal characterize both CD and ulcerative colitis. The incidence of IBD in the Crohn disease (PCD) is defined as inflammation at or near the United States is 70 to 150 cases per 100,000 individuals and, as with other anus, including tags, fissures, fistulae, abscesses, or stenosis. autoimmune diseases, is on the rise. CD can affect any part of the The symptoms of PCD include pain, itching, bleeding, purulent gastrointestinal tract from the mouth to the anus and frequently will include discharge, and incontinence of stool. perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal INCIDENCE AND NATURAL HISTORY disease has become a recognized entity and an important consideration in the Limited pediatric data describe the incidence and prevalence diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as of PCD. The incidence of PCD in the pediatric age group has been inflammation at or near the anus, including tags, fissures, fistulae, abscesses, estimated to be between 13.6% and 62% (3). -
Descriptive Study Regarding the Etiological Factors Responsible for Secondary Bacterial Peritonitis in Patients Admitted in a Te
International Journal of Health Sciences and Research Vol.10; Issue: 7; July 2020 Website: www.ijhsr.org Original Research Article ISSN: 2249-9571 Descriptive Study Regarding the Etiological Factors Responsible for Secondary Bacterial Peritonitis in Patients Admitted in a Tertiary Care Hospital in Trans Himalayan Region Raj Kumar1, Rahul Gupta2, Anjali Sharma3, Rajesh Chaudhary4 1MS General Surgery, Civil Hospital Baijnath, Himachal Pradesh 2MD Community Medicine, District Programme Officer, Health and Family Welfare, Himachal Pradesh 3Resident Doctor, Department of Microbiology, DRPGMC Kangra at Tanda, Himachal Pradesh 4MS General Surgery, Civil Hospital Nagrota Bagwan, Himachal Pradesh Corresponding Author: Rahul Gupta ABSTRACT Peritonitis is an inflammation of the peritoneum. Primary peritonitis which is spontaneous bacterial peritonitis, Secondary peritonitis due to infection from intraabdominal source or spillage of its contents and Tertiary peritonitis which is recurrent or reactivation of secondary peritonitis. The present study was aimed to determine the etiology of generalized secondary peritonitis among the patients admitted in Department of General Surgery, Dr RPGMC Kangra at Tanda. This descriptive observational study was conducted in the department of surgery Dr. Rajendra Prasad Government Medical College Kangra at Tanda consisting of patients having acute generalised secondary peritonitis presented in emergency department or Surgery outdoor patient department over a period of one year from December 2016 through November 2017. The most common etiology of generalized secondary peritonitis in our patients was peptic ulcer disease (77.13%) followed by perforated appendicitis (9.8%). Etiological factors of secondary generalised peritonitis have a different pattern in different geographical regions. Peptic ulcer disease remains the commonest etiology of secondary peritonitis in India followed by enteric perforation which is in contrast to the western studies where appendicular and colon perforations are more common. -
PERFORATED PEPTIC ULCER. Patient Usually Experiences
Postgrad Med J: first published as 10.1136/pgmj.12.134.470 on 1 December 1936. Downloaded from 470 POST-GRADUATE MEDICAL JOURNAL December, 1936 PERFORATED PEPTIC ULCER. By RONALD W. RAVEN, F.R.C.S. (Assistant Surgeon to T'he French Hospital, Assistant Surgeon to The Gordon Hospital for Rectal Diseases and Swrgical Registrar to The Royal Cancer Hospital.) INTRODUCTION. Peptic ulceration is a crippling disease judged from the stand-point of morbidity, and is also dangerous to life on account of serious complications, such as haemorrhage or perforation which may supervene during the course of the disease. These complications may occur in any patient and there are no criteria which will indicate whether or not an ulcer will bleed or perforate. When the treatment of peptic ulceration is under review it must be remembered that from 20 to 30 per cent. of these ulcers perforate. In a large series of cases I found that the incidence of perforation was 27 per cent. It is thus essential that patients suffering with peptic ulcer should be kept under continuous careful observation. Unfortunately, however, a small percentage of patients give no previous history of the peptic ulcer syndrome and perforation of the ulcer is the first indication of its presence. Recently, when considering the role of surgery in the treatment of chronic peptic ulcer, Joll stated that there has been a rise in the incidence of perforation as a complication of peptic ulcer since medical treatment has become systematized in the treatment of this disease. It must also be remembered that medical treat- Protected by copyright. -
Case Report: a Patient with Severe Peritonitis
Malawi Medical Journal; 25(3): 86-87 September 2013 Severe Peritonitis 86 Case Report: A patient with severe peritonitis J C Samuel1*, E K Ludzu2, B A Cairns1, What is the likely diagnosis? 2 1 What may explain the small white nodules on the C Varela , and A G Charles transverse mesocolon? 1 Department of Surgery, University of North Carolina, Chapel Hill NC USA 2 Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi Corresponding author: [email protected] 4011 Burnett Womack Figure1. Intraoperative photograph showing the transverse mesolon Bldg CB 7228, Chapel Hill NC 27599 (1a) and the pancreas (1b). Presentation of the case A 42 year-old male presented to Kamuzu Central Hospital for evaluation of worsening abdominal pain, nausea and vomiting starting 3 days prior to presentation. On admission, his history was remarkable for four similar prior episodes over the previous five years that lasted between 3 and 5 days. He denied any constipation, obstipation or associated hematemesis, fevers, chills or urinary symptoms. During the first episode five years ago, he was evaluated at an outlying health centre and diagnosed with peptic ulcer disease and was managed with omeprazole intermittently . His past medical and surgical history was non contributory and he had no allergies and he denied alcohol intake or tobacco use. His HIV serostatus was negative approximately one year prior to presentation. On examination he was afebrile, with a heart rate of 120 (Fig 1B) beats/min, blood pressure 135/78 mmHg and respiratory rate of 22/min. Abdominal examination revealed mild distension with generalized guarding and marked rebound tenderness in the epigastrium. -
Digestive Tract Tuberculosis
World Gastroenterology Organisation Global Guidelines Digestive tract tuberculosis March 2021 WGO Review Team Mohamed Tahiri (Chair, Morocco), K.L. Goh (Co-Chair, Malaysia), Zaigham Abbas (Pakistan), David Epstein (South Africa), Chen Min-Hu (China), Chris Mulder (Netherlands), Amarender Puri (India), Michael Schultz (New Zealand), Anton LeMair (Netherlands) Funding and conflict of interest statement All of the authors have stated that there were no conflicts of interest in relation to their authorship of this paper. Anton LeMair acts as guideline development consultant for WGO. WGO Global Guidelines Digestive tract tuberculosis 2 Contents 1 Introduction .............................................................................................................................. 4 1.1 About WGO cascades ................................................................................................................. 5 1.2 Definitions .................................................................................................................................. 5 1.3 Epidemiology .............................................................................................................................. 6 1.3.1 WHO 2018 global tuberculosis report .............................................................................. 6 1.4 Etiopathogenesis and risk factors .............................................................................................. 7 2 Clinical features ....................................................................................................................... -
Peritoneal Sclerosis and Massive Hemoperitoneum: Case Report and Short Review
Urology & Nephrology Open Access Journal Case Report Open Access Peritoneal sclerosis and massive hemoperitoneum: case report and short review Abstract Volume 7 Issue 3 - 2019 Secondary Peritoneal Sclerosis has been reported in several cases but is especially frequent Daniel Gonzalez Nunez, Jhordan Guzman, among chronic peritoneal dialysis users, being its most serious complication. Clinical suspicion in chronic PD users is no challenge as intestinal symptoms and hypoalbuminemia Felipe Matteus Acuna, Juan Guillermo Ramos, appear and radiological confirmation is usually achieved before the need for surgery and Juliana Ordonez intra abdominal findings prove confirmatory. A case report of a 37-year-old male patient Department of Surgery, Hospital Universitario Clinica San Rafael, Universidad Militar Nueva Granada, Bogota, Colombia with a 13 year long peritoneal dialysis in whom laparotomy findings were a massive hemoperitoneum, parietal/visceral peritoneum, small/large bowel and mesentery with Correspondence: Daniel Gonzalez Nunez, Department of chronic inflammatory changes, thickening and dark-brown coloration. As a distinctive Surgery, Hospital Universitario Clinica San Rafael, Universidad feature a gastroepiploic artery branch in the gastric curvature was identified with persistent Militar Nueva Granada, Bogota, Colombia, Tel +5713108667653, oozing and hemostasis was achieved. No intestinal obstruction was evident. Postoperative Email was uneventful. In patients undergoing peritoneal dialysis a hemorrhagic effluent from the catheter or -
A Case Series on Intussusceptions in Infants Presenting with Listlessness
ABDOMINAL CONDITIONS © 2010 SNL All rights reserved A case series on intussusceptions in infants presenting with listlessness Intussusception is characterised by abdominal pain, vomiting and blood in stools. However, in younger infants it may present with non-classical symptoms such as listlessness, pallor, decreased feeding, and being non-specifically unwell. Three cases of intussusception in young infants who presented with being listless and had some or no features to suggest a clinical diagnosis of intussusception are described which are designed to highlight the non-classical features of intussusception likely to be encountered in very young infants. Siba P. Paul1 ntussusception is one of the most tachycardia and prolonged capillary refill MBBS, DCH Icommon surgical emergencies time he was given a fluid bolus of 20mL/kg Paediatric Trust Registrar encountered in infancy and early with 0.9% sodium chloride. He was [email protected] childhood. This is a condition where the intermittently responding to his parents proximal segment of the bowel telescopes but was not irritable. His cardiovascular 1 David C. A. Candy into the distal segment causing and respiratory examination was MBBS, MSc, MD, FRCP, FRCPCH, FCU obstruction1. The classic triad of symptoms otherwise normal. Consultant Paediatric Gastroenterologist consists of abdominal pain, vomiting and He was distressed by an abdominal blood in stools1. It is often seen in children Nikila Pandya2 examination and was found to be drawing aged four months to two years, with a peak up his legs and crying while being MD, DCH, FRCPCH incidence during four to nine months of Consultant Paediatrician examined. The provisional diagnosis at age2. -
Effect of Peritoneal Lavage with Coconut Water in Healing of Colon Anastomosis in Rat Abdominal Sepsis Model
Effect of Peritoneal Lavage with Coconut Water in Healing of Colon Anastomosis in Rat Abdominal Sepsis Model Efeito da Lavagem Peritoneal com Água de Coco na Cicatrização de Anastomoses do Cólon em Modelo de Sepse Abdominal em Ratos Bárbara Bruna de Sousa Pires1, Ítalo Medeiros Azevedo2, Marília Daniela Ferreira de Carvalho Moreira2, Lívia Medeiros Soares Celani3, Aldo Cunha Medeiros4 1. Graduate student, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil. 2. Fellow PhD degree, Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil. 3. MD, University Hospital Onofre Lopes, UFRN, Natal-RN, Brazil. 4. Full Professor, Chairman, Nucleus of Experimental Surgery, UFRN, Natal-RN, Brazil. Study performed at Department of Surgery, Federal University of Rio Grande do Norte (UFRN), Brazil. Financial support: none. Conflict of interest: None. Correspondence address: Department of Surgery, Federal University of Rio Grande do Norte, at Ave. Nilo Peçanha 620, Natal, RN, Brazil. E-mail: [email protected] Submitted: June 10, 2017. Accepted, after review: July 22, 2017. ABSTRACT Purpose: The objective of this study was to evaluate the efficacy of peritoneal lavage with coconut water in the healing of colonic anastomoses in a model of abdominal sepsis in rats. Methods: Twelve Wistar rats were used. The animals were randomly selected and distributed in 2 groups, with six rats each. Group 1: rats with sepsis + peritoneal lavage with 0.9% saline solution and Group 2: rats with sepsis + peritoneal lavage with coconut water. Induction of abdominal sepsis was performed through the exteriorization of the cecum and ligature. -
A Challenging Case of Recurrent Eosinophilic Peritonitis
Open Access Case Report DOI: 10.7759/cureus.9422 A Challenging Case of Recurrent Eosinophilic Peritonitis Myra Nasir 1 , Jasmin Hundal 1 , Arish Noor 1 , Juan Jose Chango Azanza 1 , Jaimy Villavicencio 1 1. Internal Medicine, University of Connecticut, Farmington, USA Corresponding author: Myra Nasir, [email protected] Abstract Eosinophilic peritonitis is a rare presentation of eosinophilic gastroenteritis and is characterized by eosinophil-rich inflammation in any part of the gastrointestinal tract in the absence of secondary causes of eosinophilia. We report a case of a 48-year-old female who had recurrent hospital admissions due to abdominal pain and distension secondary to relapsing eosinophilic peritonitis. Categories: Allergy/Immunology, Gastroenterology Keywords: idiopathic eosinophilic peritonitis, eosinophilic gastroenteritis, ascites Introduction Eosinophilic peritonitis (EP) is a rare presentation of eosinophilic gastroenteritis (EGE) [1]. Patients often present with abdominal distension, which can be accompanied by nausea, vomiting, diarrhea, and abdominal pain. The pathogenesis is poorly understood. We report the case of a 48-year-old female who had recurrent admissions for abdominal pain and distension and was found to have eosinophilic cholecystitis and EP. Case Presentation A 48-year-old female with a past medical history significant for asthma and bronchitis presented to the hospital in October 2018 with worsening abdominal pain associated with abdominal distension evolving over three weeks and diarrhea for three days. One month prior to this, she had undergone cholecystectomy, with tissue biopsy revealing eosinophilic cholecystitis (Figure 1). Her medications included furosemide 20 mg and pantoprazole 40 mg daily. She denied using any over-the-counter or herbal medications. Physical examination revealed a distended abdomen, diffusely tender to palpation. -
Abdominal Pain
10 Abdominal Pain Adrian Miranda Acute abdominal pain is usually a self-limiting, benign condition that irritation, and lateralizes to one of four quadrants. Because of the is commonly caused by gastroenteritis, constipation, or a viral illness. relative localization of the noxious stimulation to the underlying The challenge is to identify children who require immediate evaluation peritoneum and the more anatomically specific and unilateral inner- for potentially life-threatening conditions. Chronic abdominal pain is vation (peripheral-nonautonomic nerves) of the peritoneum, it is also a common complaint in pediatric practices, as it comprises 2-4% usually easier to identify the precise anatomic location that is produc- of pediatric visits. At least 20% of children seek attention for chronic ing parietal pain (Fig. 10.2). abdominal pain by the age of 15 years. Up to 28% of children complain of abdominal pain at least once per week and only 2% seek medical ACUTE ABDOMINAL PAIN attention. The primary care physician, pediatrician, emergency physi- cian, and surgeon must be able to distinguish serious and potentially The clinician evaluating the child with abdominal pain of acute onset life-threatening diseases from more benign problems (Table 10.1). must decide quickly whether the child has a “surgical abdomen” (a Abdominal pain may be a single acute event (Tables 10.2 and 10.3), a serious medical problem necessitating treatment and admission to the recurring acute problem (as in abdominal migraine), or a chronic hospital) or a process that can be managed on an outpatient basis. problem (Table 10.4). The differential diagnosis is lengthy, differs from Even though surgical diagnoses are fewer than 10% of all causes of that in adults, and varies by age group. -
The Digestive Tract As the Origin of Systemic Inflammation Petrus R
de Jong et al. Critical Care (2016) 20:279 DOI 10.1186/s13054-016-1458-3 REVIEW Open Access The digestive tract as the origin of systemic inflammation Petrus R. de Jong1,2*, José M. González-Navajas3,4 and Nicolaas J. G. Jansen1 Abstract Failure of gut homeostasis is an important factor in the pathogenesis and progression of systemic inflammation, which can culminate in multiple organ failure and fatality. Pathogenic events in critically ill patients include mesenteric hypoperfusion, dysregulation of gut motility, and failure of the gut barrier with resultant translocation of luminal substrates. This is followed by the exacerbation of local and systemic immune responses. All these events can contribute to pathogenic crosstalk between the gut, circulating cells, and other organs like the liver, pancreas, and lungs. Here we review recent insights into the identity of the cellular and biochemical players from the gut that have key roles in the pathogenic turn of events in these organ systems that derange the systemic inflammatory homeostasis. In particular, we discuss the dangers from within the gastrointestinal tract, including metabolic products from the liver (bile acids), digestive enzymes produced by the pancreas, and inflammatory components of the mesenteric lymph. Keywords: Acute inflammation, Gastrointestinal failure, Gut-liver crosstalk, Pancreatitis Abbreviations: ARDS, Acute respiratory distress syndrome; CCK, Cholecystokinin; DCA, Deoxycholic acid; FFA, Free fatty acid; G-I, Gastro-intestinal; GPR, G-protein-coupled receptor; -
Peritoneal Fluid in the Rabbit: Permeability of the Mesothelium to Proteins, Lipoproteins and Acid Hydrolases F.C
Lymphology 8 (1975) 1-10 (Q Georg Thieme Verlag, Stuttgart Peritoneal Fluid in the Rabbit: Permeability of the Mesothelium to Proteins, Lipoproteins and Acid Hydrolases F.C. Courtice, D.C.K. Roberts Department of Experimental Pathology, John Curtin School of Medical Research, Australian National University, Canberra Summary The peritoneal fluid in rabbits fed a normal and a cholesterol added diet was analysed for a wide variety of macromolecules of different size, viz albumin, a-, /J- and -y-globulins, high density lipoprotein and lipoproteins of Sf0-12, Sfl2-20 and Sf>20 and three acid hydrolases, N-acetyl--/hi-glucosaminidase, acid phosphatase and /J-glucuronidase. The composition of the lipoproteins and the concentrations of each substance were compar ed with corresponding values in plasma, hepatic lymph, thoracic duct lymph and leg lymph. The results indicate that the large lipoproteins of the thoracic duct lymph derived from the intestinal mucosa do not normally enter the peritoneal cavity probably because they do not mix with the subserous tissue fluid, that the macromolecular composition of peritoneal fluid resembles that of leg lymph, that the peritoneal meso thelium is freely permeable to these macromolecules and that the main plasma: peritoneal fluid barrier resides in the blood capillary membrane of the various subserous tissues. Introduction The peritoneal cavity usually contains a small amount of free fluid which has a protein concen tration of about 2.5 g/100 ml (2, 35). The origin of this fluid is not certain, but it is probably derived from the several adjacent subserous tissue fluid pools. The mechanisms concerned in the passage of proteins through the mesothelial lining of the cavity are, however, not well under stood.