Spontaneous Bacterial Peritonitis - GeoCities自发性细菌性腹膜炎-地理.doc

Abdominal pain and Tenderness 14/03/02 STEVENSIU Peritonitis = Inflammation of the peritoneum (Primary) Spontaneous Bacterial Peritonitis (Secondary) Peritonitis Chemical Peritonitis Bacterial peritonitis Learning Objectives 1 Describe the anatomy and physiology of the peritoneum, including the innervations of the visceral and parietal layers The peritoneum is a continuous, transparent serous membrane that lines the abdominopelvic cavity and invests the viscera. It consists of two continuous layers. Parietal peritoneum- lining the internal surface of the abdominopelvic wall. Visceral peritoneum – investing the viscera Visceral peritoneum supplied small type C pain fibers and can only response to chronic-aching suffering type of pain. These fibers can response to ischaemia, chemical stimuli, and spasm of a hollow viscus and over distention of a hollow viscus Parietal peritoneum is supplied by the spinal nerves not sympathetic nerves( sharp localized somatic pain Learning objectives 2 Discuss conditions predisposing to spontaneous bacterial peritonitis (SBP) SBP= The inflammation of the peritoneum without a clear event such as bowel perforation that would account for the entry of the pathogenic organism Liver Cirrhosis is the main predisposing factor. Other conditions leading to ascites e.g. Fulminant hepatic failure, Congestive heart failure, liver metastases can also predispose to SBP. Pathogenesis Seeding( The exact pathogenic mechanism is unknown. Bacterial seeding is believed to involve haematogenous spread of organisms in a patient in whom diseased liver and altered portal circulation result in a defect in the usual filtration. Growth-- The reduced levels of complement cascade and reduced opsonic and phagocytic properties of neutrophils in advanced liver cirrhosis in an excellent culture medium provided by the ascitic fluids, promote the growth of the organisms. Symptoms Fever, Hypotension, Decreased or absent bowel sounds, Abdominal Pain and Abrup