1. The department of the faculty and hospital surgery of the medical faculty of the Tashkent medical academy
Acute
peritonitis

2. Clinic of peritonitis firstly was described by military doctor Vasiliy Shabanov in 1816,
Which described peritonitis in young soldier after perforation of duodenum

3. In 1881 Smidt L.I. from Moscow became pioneer in performing
Laparotomy in patient with diffuse purulent peritonitis

4. Способ лечения перитонита
СООЗ СОВЕТСНИХ СОЦИАЛИСТИЧЕСКИХ РЕСПУБЛИК ГОСУДАРСТВЕННЫЙ КОМИТЕТ СССР ПО ДЕЛАМ ИЗОБРЕТЕНИЙ И ОТКРЫТИЙ ОПИСАНИЕ ИЗОБРЕТЕНИЯ К АВТОРСКОМУ СВИДЕТЕЛЬСТВУ (72)
Ш. И. Каримов, К. Н. Турсунов,
А. А. Асраров и Б. П. Бабаджанов (71)
Ташкентский ордена Трудового Красного Знамени государственный медицинский институт (56) Травин А. А. и др.
Формирование дренажных, систем при перитоните. В кн.: Гнойный перитонит. Труды Московского НИИ скорой помощи им. И. В. Склифосовского т. ХХХУ11М., 1979, с , (54)(57) СПОСОБ ЛЕЧЕНИЯ ПЕРИТОНИТА путем дренирования верхнего и нижнего отделов брюшной полости, о т л и—. ч а ю щ и й с я тем,...
Номер патента: | Автор(ы): Асраров, Бабаджанов, Каримов, Турсунов |
Метки: лечения, способ,перитонита | Опубликовано: 
Karimov Sh.I.

5. well-manered in a fair of God and peritonitis»
« Me and my generation are
well-manered in a fair of
God and peritonitis»
acad. Vagner (1876).

6. Peritonitis – inflammation of the visceral and parietal peritoneum, which conduct by the own diseases and during short time induct the defeats of the patient.

7. STATISTIC
1. Peritonitis frequently complicates the course of acute surgical diseases of the abdomen and occurs in 20-25% of patients;
2 Ranked Among the deaths from acute surgical diseases of the abdominal cavity dies of peritonitis 67-70% of patients;
3 still peritonitis is a major cause of death in acute appendicitis, perforated gastric ulcer and duodenal ulcer, strangulated hernia, acute cholecystitis and acute intestinal obstruction (60 to 90%).

8. Spreading of the peritonitis
Primary
Females
Males
Secondary

9. Postoperative peritonitis
Death from the peritonitis
Савчук Б.Д., 1979
Шалимов А.А., 1981
Попов В.А.,
Гостищев В.К., 2002
Acute peritonitis
Postoperative peritonitis

10. The reasons of the high morbidity at the peritonitis:
Late addressing of the patients.
Significant increasing of the number of the patients of elder and senile age.
3) Increasing of the number of the oncologic diseases.
4) Increasing of the number of the patients with the diabetes.
Resistance of the microorganisms to the antibiotics and not enough efficiency of the antibacterial therapy.
6) Mistakes of the diagnostic and surgical tactic.
7) Special gravity of the currency of the festering process.

11. Etiology of the peritonitis
1. Microbe (bacterial) peritonitis:
Not specific, inducted with the microflora of the GIP.
Specific, inducted with the microflora not from GIP
2. Aseptic (abacterial) peritonitis
3.Traumas and defeats of the organs of the abdominal cavity.
4. Special forms of the peritonitis:
canceromatous, parasite, reumatoid,
granulematous.

12. Main sources of the infection of the abdominal cavity
Appendix 30-65%
Stomach and duodenum 7-14%
Female reproductive organs 3-12%
Intestine 3-5%
Gall bladder10-12%
Pancreas 1%
Postoperative peritonitis %
Traumatic defeats 2,7%

13. Acute gangrenous appendicitis
Flegmona of the stomach

14. Acute flegmonous cholecystitis
Reasons of the peritonitis
Acute flegmonous cholecystitis
холецистит
Tube pregnancy
Breakup of the gonad’s cyst

15. Abscess of the pancreas
Crone’s disease
Abscess of the pancreas
Flegmona of the caecum

16. Strangulation of the
hernias.
Wall strangulation

17. Classification by B.D. Savchuk, 1979
I.Local peritonitis.
1)Limited
2)Not limited.
II. Spreaded peritonitid.
1)Diffuse
2)Poure.

18. By the stages of the currency
Reactive
(the first 24 h.)
Terminal
(over 72 h.)
Toxic
(24-72 h.)

19. Clinic picture of the acute pancreatitis depends on
Reactivity of the organism
Etiology of the peritonitis
Localization of the
process
Spreading of the process
Stage of the disease
Virulent of the microflora

20. Symptoms of the acute pancreatitis Local
General
Local
Constant symptoms of the acute pancreatitis
Not constant symptoms of the acute pancreatitis

21. Constant symptoms of the peritonitis
Pain in the abdomen, pain at the palpation of the abdomen
Shetkin-Blumberg’s symptom
Muscular effort of the anterior abdominal wall
Dry and covered tongue
Sickness, retching, thirst
Hippocrates's face
Paresis of the intestine, stopping of the gases and excrements.
Change of the breathing
Rising of the temperature, backlog of the temperature from the pulse “scissor's symptom”
Pain at the research from the rectum
Leucocytosis in bloodв крови, movement to the left, acceleration of SES
Changes in urine

22. Symptoms of the acute peritonitis at the reactive stage General Local
Acceleration to 120 beats in a min.
Pain in the abdomen
Significant effort of the abdominal muscules
Increased BP
Выраженный симптом Щеткина-Блюмберга
Acceleration of the breathing
Rising of the temperature
The peristaltic of the
Intestines is reduced

23. Symptoms of the acute peritonitis at the toxic stage Local General
Reducing of the Pain in the abdomen
Increased pulse over 120 beats in a min.
Reducing of the effort of the muscles of the abdomen
Reducing of the BP
Euphoria
Shetkin-Blumberg is not significant
Sharp lines of face, pallor
The intestinal peristaltic
isn’t heared
Hectic temperature

24. Symptoms of the acute peritonitis at the terminal stage Local General
Hippocrates's face
Poured pain in the
all abdomen
Adynamy
Significant meteorism
Intoxicated dilirium
Absence of the intestinal
peristaltic
Retching with the smell of the excrement
Decreasing with the uretra
PON

25. Diagnostic f the acute peritonitis
Complaints
Anamnesis of life and disease
Objective status
Local status
Clinic-biochemical researhes

26. Instrumental methods of researches
Not invasive US
Overview X-ray
Rheography
Invasive
laparocentesis
Method of the wandering catheter
Diagnostic laparoscopy
Diagnostic laparotomy

27. US of the abdominal cavity
Presence of the free liquid in the abdominal cavity

28. Overview X-ray of the abdominal cavity
At the overview X-ray overwinding chalices of Cloyber
Presence of the gas and loquid in the extended intestine

29. Diagnostic laparoscopy
Is the reliable method, that allows directly find out the source of the peritonitis, presence and character of the exudates.

30. Diagnostic laparotomy
In the complicated cases aloows in good time state the most right diagnosis

31. Treatment of the patients with the acute peritonitis includes three periods:
Preoperative preparation
Operative treatment
Postoperative preparation

32. Problem of the preoperative preparation
At one side
Is the correction
of defeated functions
to the level at which
the surgical treatment is
the least dangerous
At another
It is necessary to liquidate
the festering process in
the abdominal cavity (reason
of the defeat of the haemosta
sis), that limits with the
minimal short terms
of decision of all treatment-
diagnostic problems of the period

33. Early operative intervention
As harder the state of the patient, so longer lasts the preoperative preparation
Not more than 2 hours
Early operative intervention

34. I. correction of the volume, electrolytes and microcirculatory defeats
Lactosol
Disol
Ringer’s
Solution
Лактосоль
Дисоль
Раствор
Рингера
Лактосоль
Дисоль
Раствор
Рингера
Лактосоль
Дисоль
Раствор
Рингера
Лактосоль
Дисоль
Раствор
Рингера
30-40ml 10% sol. Chloride
calcium
30-40мл 10% р-ра хлористого
калия
30-40мл 10% р-ра хлористого
калия
30-40мл 10% р-ра хлористого
калия
Rheopoly
glucin
and haemodes

35. II. Correction of the peptide defeats
Альбумин мл
Albumin ml
FFP ml
С З П мл or

36. III. Decompression of the GIP and reducing of the secretion
Zantak 2,0 i\m
To reduce the secretion of the GIP and prevent the aspiration

37. Preoperative preparation includes
VI. Устранение анемии
VI. Liquidation of the
anemia
VII. Liquidation of the
metabolic acidosis
VII. Устранение
метаболического
ацидоза
VIII. Блокада
болевых
импульсов
VIII. Blockade of the
painful impulses

38. Preoperative preparation includes:
IX. Введение
глюкокортикоидов
IX. Введение
глюкокортикоидов
IX. Introducing of the
glucocorticoids
X. Введение
ингибиторов
протеаз
X. Introducing of the
inhibitors of
the proteases
X. Введение
ингибиторов
протеаз
XI. Антибактериальная
терапия
XI. Antibacterial therapy

39. The main method of treatment of the acute peritonitis
Urgent operative treatment

40. Main principles of the operative treatment at the peritonitis
General anesthesia with forced breathing
Wide access
Revision of the organs of the abdominal cavity
Liquidation of the source of the peritonitis
Sanation of the abdominal cavity
Nasointestinal intubation
Drainage of the abdominal cavity

41. Frequently used access at the acute peritonitis:
Middle-median laparotomy

42. State of the peritoneum
color,
transparency
thickness,
hypostasis,
hyperemia,
injection of the vessels

43. Characteristic of the exudates
Serous
Serous-fibrinous
Fibrinous-pus
Hemorrhagic
Ichorous
Urine
Bilious
Excremental
Mixed

44. Revision of the organs of the abdominal cavity
Main rule:
solving of the stages of revision of the organs of the abdominal cavity.

45. Liquidation of the source of the peritonitis Appendectomy
Acute destructive appendicitis
Appendectomy

46. Cholecystectomy Liquidation of the source of the peritonitis
Acute destructive cholecystitis
Cholecystectomy

47. Liquidation of the source of the peritonitis
Peritonitis on the background of the gangrene of the intestine
Resection of the intestine with the EEA “side-by-side”.

48. Liquidation of the source of the peritonitis
Peritonitis on the background of the perforation of the ulcer of stomach
Sewing of the perforation
Resection of the stomach

49. Choose of the operative treatment at the gastroduodenal peritonitis
Stage
of fermentative peritonitis
Stage
of festering peritonitis
Radical operation
Palliative operation
Resection of the stomach
TV+antrumectomy
Sewing of the perforative ulcer
TV+ДЖО

50. Nasointestinal intubation

51. Drainage of the abdominal cavity
At the local peritonitis – drainage by 1 or 2 drainages
At the diffuse peritonitis – drainage by 2 or 3 drainages
Drainage at the poured peritonitis

52. Peritoneal dialysis
Method of cleaning of the organism from the bad materials, based on the high adsorption possibility of the peritoneum.
Essence of the dialysis:
Internal ambience of the organism
Dialysing solution
Half-permeable membrane

53. я
Running dialysis

54. The abdominal cavity is filledя
The abdominal cavity is filled
by the dialysate
Fractional dialysis

55. я
ДРЕНИРОВАНИЕ БРЮШНОЙ ПОЛОСТИ ПО МЕТОДУ КЛИНИКИ.
Method of our clinic

56. Complications at the peritonitis
Specific
Not specific
complications in a wound and anyerior abdominal cavity: ffestering of a wound, flegmona of the anterior abdominal wall.
abscess of the abdominal cavity
eventration
paralytic intestinal obstruction
defeat of stitches
postoperative peritonitis
intestinal fistulas
sepsis.
Hypostatic pneumonia,
Thromboembolic complications
Encephalopathy, delirium
DIC - syndrome,
Acute brathing, heart- vascular, renal-hepatic insufficiency.

57. Duties of the general practitioner in peritonitis
- Provision of primary health and social care;
- Health education (promoting healthy lifestyles);
- Preventive work (timely detection of early and latent forms of the disease, risk groups);
- Dynamic monitoring;
- Emergency assistance in case of emergency and acute conditions;
- Timely consultation and hospitalization in the prescribed manner;
- Medical and rehabilitation work in accordance with the qualifying characteristic;
- An examination of temporary disability;
- The organization of medical and social care and household together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill;
- Maintaining the approved forms of records and reports.