Sunteți pe pagina 1din 62

UNIVERSITATEA DE VEST

FACULTATEA DE MEDICINA ,FARMACIE


SI MEDICINA DENTARA
SPECIALIZAREA ASISTENTA MEDICALA
LUCRARE DE DIPLOMA
PERITONITA ACUTA
COORDONATOR

ABSOLVENT:

MOTTO
Sntatea seamn cu pacea.
Te poi bucura de ea numai dac tii s o aperi.
2
CUPRINS:
MOTIVATIE
INTRODUCERE
PARTEA GENERALA
CAPITOL I
Prezentarea bolii Peritonita a!ta
CAPITOL II
Cla"i#iarea bolii
CAPITOL III
Etiolo$ie
CAPITOL IV
Fizio%atolo$ie
CAPITOL V
Si&%to&atolo$ie
CAPITOL VI
Dia$no"ti!l 'i#erential
CAPITOL VII
Trata&ent!l in %eritonita a!ta
CAPITOLUL VIII
Rol!l a"i"tentei &e'iale in in$ri(irea
%aient!l!i ! %eritonita a!ta
CAPITOLUL IX
Prezentare az I
Prezentare az II
Prezentare az III
MATERIAL SI METODA
CONCLUZII )*
BIBLIOGRAFIE
+
MOTIVATIA
S!nt a"i"tenta &e'iala "i l!rez intr,!n "%ital in "etia -lo .%erator "i
intr! 'e" in ontat ! "!#erinta oa&enilor/
De la %ri&!l ontat ! bolna0!l, %ana an' ae"ta %ara"e"te "%ital!l,
0in'eat, 'eiziile "i ati!nile 1ir!r$!l!i "i a"i"tentei &e'iale treb!ie "a #ie e#ete
ale $an'irii 1ir!r$iale, "a %oarte %eetea ei/ 2an'irea 1ir!r$iala e"te $an'irea
%arti!lara, are $!0erneaza obiet!l ati0itatii 1ir!r$!l!i3 re"tabilirea "anatatii
"a! el %!tin a&eliorarea "!#erintei bolna0!l!i, e"te e4%re"ia "o%!l!i 1ir!r$iei/
A%aritia ei e"te "tran" le$ata 'e on"tit!irea 1ir!r$iei a 'o&eni! 'e ati0itate/
C1ir!r$ia a 'o&eni! 'e ati0itate, e"te "tiinta "i arta, in aela"i ti&%, e are
a "o% re'area "anatatii bolna0ilor "a! el %!tin !"!rarea "!#erintelor lor C1ir!r$ia
n! "e %ratia '!%a #or&!le &ate&atie, ne#iin' %o"ibil "a #ie tran"%!"a in e!atie
'e ti%!l A 5 - 6 A re%rezentan' 'ia$no"ti!l a#eti!nii 1ir!r$iale in a!za, iar -
inter0entia 1ir!r$iala nee"ara re'arii "anatatii bolna0!l!i 'eoaree are a obiet
bolna0i, "i n! boli , "i #ieare bolna0, a "tr!t!ra #izia "i %"i1ia, a &o' 'e
reatie la boala, a "it!atie o%eratorie "i a ra"%!n" la "oliitarile o%eratiei, e"te o
in'i0i'!alitate/
A $an'i e0a "a! a $an'i la e0a, 'enota on"tiinta !nei 'iretii atre !n
'o&eni! 'e i'ei "a! atre o "#era one%t!ala/ A $an'i %rin tine in"!ti in"ea&na a
%!ne in (o intrea$a ta a%aitate 'e 'i"erna&ant in in"!"irea %arerilor altora #ara
a le ra&ane 0a"al re'inio" %entr! a 1ir!r$ia e"te o "tiinta nobila "i in 1ir!r$ie
a%ar l!r!ri noi/
7
INTRODUCERE
Peritonita re%rezinta o reatie in#la&atorie a %eritone!l!i, are %oate #i
'i#!za "a! loalizata, 'e ori$ine in#etioa"a "a! n!/ Ma(oritatea %eritonitelor "!nt
'e ori$ine in#etioa"a, ei &ai #re0enti a$enti %ato$eni #iin' E"1eri1ia oli,
enterooi, 8leb"iela, Enterobater, Prote!", -ateroi'e"/ Ca0itatea %eritoneala "e
intin'e 'e la 'ia#ra$& 6ranial9 %ana la %el0i" 6a!'al9, "i 'e la %eretele ab'o&inal
6anterior9 %ana la 0i"erele retro%eritoneale 6aorta, 0ena a0a, !retere, rini1i9/
Peritone!l e"te #or&at 'in 'o!a "trat!ri, !n!l intern 6%eritone!l 0i"eral9 "i
!n!l e4tern 6%eritone!l %arietal9 / Cele &ai &!lte %eritonite 6%e"te *:;9 a%ar
'atorita 'i"tr!$erii trat!l!i $a"tro,inte"tinal 6%eritonite "e!n'are9, at!ni an' in
li1i'!l %eritoneal "e i'enti#ia &!lti%li $er&eni ! ori$ine enterala/ Un %roent
&!lt &ai "az!t il re%rezinta %eritonitele in are e"te %a"trata inte$ritatea
trat!"!l!i $a"tro,inte"tinal "i a%ar in ab"enta inter0entiilor 1ir!r$iale "a! a
tra!&ati"&elor 6%eritonite %ri&are9/
Pentr! 'ia$no"ti!l 'e %eritonita "!nt #oarte i&%ortante i"tori!l bolii "i
e4a&en!l #izi/ A"t#el, 'aa %aient!l %rezinta !n i"tori 'e "%italizari reente, boli
ronie, inter0entii 1ir!r$iale reente, #ebra, #ri"on, '!rere 'e inten"itate re"!ta
la ni0el ab'o&inal "e ri'ia "!"%ii!nea 'e %eritonita/ 2reata "i 0ar"at!rile "!nt 'e
a"e&enea "i&%to&e i&%ortante iar %al%area ab'o&en!l!i arata a%arare &!"!lara
6ontrat!ra %eretel!i ab'o&inal e a%are in ti&%!l %al%arii9 "i ontrat!ra
&!"!lara 6ontrat!ra &!"!lara ne%ro0oata 'e atin$erea ab'o&en!l!i9 in
%eritonita a!ta/ In &o&ent!l in are ",a "tabilit 'ia$no"ti!l 'e %eritonita a!ta,
trata&ent!l treb!ie "a #ie %ro&t %entr! a e0ita o e0ol!tie ne#a0orabila "%re "e%"i" "i
a%oi e4it!" 6'ee"9/ Trata&ent!l 'e eletie e"te el 1ir!r$ial, "i on"ta in
eli&inarea "!r"ei 'e onta&inare, re'!erea onta&inarii, tratarea in#etiei
rezi'!ale "i %re0enirea re!rentei in#etiilor/ E0ol!tia %o"to%eratorie e"te
<
#a0orabila 'aa trata&ent!l 1ir!r$ial a #o"t %ro&t "i e"te o&%letat ! trata&ent
antibioti/ A%aritia !nei %eritonite %re"!%!ne 'e obiei interati!nea a trei #atori3
in!n'area bateriana a a0itatii %eritoneale, 0ir!lenta re"!ta a ae"tor a$enti
%ato$eni "i "labirea &i(loaelor 'e a%arare loala "a! $enerala/ In %eritonitele
%ri&are onta&inarea "e #ae %e ale 1e&ato$ena in !r"!l !nei baterie&ii
6%rezenta bateriilor in "an$e9, ae"tea #iin' 'e obiei in#etii ! !n "in$!r $er&ene
"i a%ar in "%eial la o%ii "i i&!no'e%ri&ati/ Peritonitele "e!n'are a%ar 'atorita
lezi!nii !n!i 0i"er ab'o&inal "a! a trat!l!i 'i$e"ti0/ Carateri"tiile $er&enilor
in %eritonitele "e!n'are ore"%!n' in $eneral #lorei or$an!l!i lezat/ Flora nor&al
a e"o#a$!l!i, "to&a!l!i, '!o'en!l!i "i a %artii %ro4i&ale a inte"tin!l!i "!btire e"te
"araa, a%oi ine%e "a rea"a %ro$re"i0 la ni0el!l inte"tin!l!i 'i"tal, a"t#el a #lora
olon!l!i e"te #oarte bo$ata/
=
PARTEA GENERALA
CAPITOL I
PERITONITA ACUT
Peritone!l e"te o "eroa"> #oarte ?ntin">, ?n ra%ort!ri ! toate or$anele
ab'o&inale, ! o 0a"t> re@ea 'e 0a"e "an$!ine, li&#atie Ai "er!ri, >reia i "e
on#er> rol!ri #iziolo$ie Ai #izio%atolo$ie #oarte i&%ortante/
Peritone!l inter0ine ?n %roe"ele 'e a%>rare ale or$ani"&!l!i, rea@ioneaz>
%rintr,o e4"!'a@ie ab!n'ent>, %ro'!ere 'e #ibr> Ai antior%i are tin' "> li&iteze
in#e@iile/
Datorit> %ozi@iei "ale ?n %le4!rile ner0oa"e, %eritone!l on"tit!ie o "!%ra#a@>
interoe%ti0>, la ei &ai 0aria@i e4itan@i, eea e e4%li> t!lb!r>rile re#le4e loale
la 'i"tan@> Ai $enerale, are a%ar ?n ?&boln>0irile ae"tei "eroa"e/
DEFINIIE
Re%rezinta in#la&atia 'i#!za a %eritone!l!i, in ea &ai lar$a ae%ti!ne 'e
ori$ine "e%tia/ Peritonita a!ta 'i#!za e"te !na 'in &arile !r$ente ab'o&inale/
Peritonitele "!nt 'eter&inate 'e ra"%an'irea bateriilor 'intr,!n or$an %er#orat in
trat!l $a"trointe"tinal "a! $enito!rinar, 'e obiei rez!ltan' ab'o&en!l a!t
1ir!r$ial/ In#etiile "!nt intot'ea!na a&e"teate, ! E/ Coli, -ateroi'e" #ra$ili"
"i alte or$ani"&e #a!ltati0e "i anaerobe $ra& ne$ati0e %re'o&inante/
Peritonitele %ri&iti0e 6%ri&are9 "a! %eritonitele "%ontane, a! "!r"a 'e
onta&inare e4tra%eritoneala iar tran"%ort!l a$ent!l!i %ato$en "e realizeaza %e ale
ir!latorie/ Ae"tea a%ar atat la o%ii at "i la a'!lti, ! %re'iletie in !lti&!l ti&%
%entr! a'!lti
)
B
CAPITOL II
CLASIFICARE
I. Dup faza !"#u$%! & 'eo"ebi& 'o!> #el!ri 'e %eritonit>3
a/ %eritonita a!t>
b/ %eritonita roni>
II. Dup #"'a#%za( 3
- %eritonite a%en'i!lare
- %eritonite biliare
- %eritonite !rinare
- %eritonite enterale 6inte"tinale9, et/
III. Dup )"*u# * a + p("*u' :
- %eritonit> loalizat> 6ir!&"ri">9
- %eritonit> $eneralizat>
D"+,%) *"u f#u(% * p(%$"-%$ a'u$ :
- %eritonit> a!t> loalizat>
- %eritonit> a!t> $eneralizat>
a/ Peritonit acut localizat e"te aea #or&> ?n are &i(loaele 'e a%>rare
e4i"tente ?n a0itatea ab'o&inal> re!Ae" "> loalizeze %roe"!l in#e@io" ?n
re$i!nea ?n are el a a%>r!t/
De e4e&%l!3 %eritonita loalizat> 'e ori$ine a%en'i!lar> 6!no"!t> Ai "!b
n!&ele 'e %la"tron9 "a! blo a%en'i!lar, %eritonit> loalizat> 'e ori$ine
olei"ti> 6%la"tro& olei"ti9, %eritonit> loalizat> 'in re$i!nea %el0in>
6%el0i%eritonit>9/
b/ Peritonita acut difuz (generalizat) e"te aea #or&> %rin are "e ?n@ele$e !n
"in'ro& in#e@io" o&%le4, ab'o&inal, 'eter&inat 'e %>tr!n'erea ?n a0itatea
%eritonial> a !nor $er&eni %ato$eni ! 0ir!len@> #oarte re"!t>/
*
CAPITOL III
ETIOLOGIE
P>tr!n'erea $er&enilor %ato$eni ?n a0itatea ab'o&inal> "e %oate #ae %e
&ai &!lte >i3
Prin %er#orarea !n!i or$an a0itar 'atorit> !n!i %roe" %atolo$i al ae"t!ia
6e0ent!alitatea ea &ai #re0ent>9
Apa( .-:
1. ulcerul gastric sau duodenal perforat
2. apendicit acut gangrenoas perforat
3. colecistit acut perforat
4. ulceraii i perforaii intestinale de diferite cauze
5. gangrenarea unei anse intestinale infarctizate sau
ocluzionale, etc.
Prin %er#orarea !n!i or$an a0itar, 'atorit> !n!i tra!&ati"& are n! a 'e"1i"
%eretele ab'o&inal 6"to&a, inte"tin, et/9/ Ae"t ti% 'e lezi!ne e"te !no"!t "!b
'en!&irea 'e tra!&ati"& ab'o&inal ?n1i"/
Prin in#etarea %eritone!l!i 'atorit> !n!i a$ent 0!lnerabil 6ar&e albe, $lonte,
"1i(e, et/9 are 'e"1i'e %eretele ab'o&en!l!i, l>"Cn' a %eritone!l "> #ie e4%!"
!nei in#e@ii ! $er&eni 'in a#ar>/
Dn az!l Cn' a$ent!l 0!lnerant a %er#orat !n or$an a0itar, %eritonita "e
%ro'!e Ai %rin re0>r"area on@in!t!l!i "e%ti %e are ?l on@ine or$an!l re"%eti0 ?n
a0itatea %eritoneal>/ Ae"t ti% 'e lezi!ne "e n!&eAte tra!&ati"& ab'o&inal
'e"1i"/
Prin 'i"i&inarea $er&enilor %ato$eni 'intr,!n %roe" ab'o&inal, la ?ne%!t
loalizat Ai a%oi $eneralizat/
E:
U#'(u# /a+$("0*u"*-a#
At!al #re0enta e in "a'ere "i 'e"i &ani#e"tarile "i&%to&atie a! ini'enta
re"!ta, ele "!nt 'e #a%t 'eter&inate 'e %atolo$ia #!ntionala ti% 'i"%e%"ie in"a
an' a%are, e0ol!tia e"te in'el!n$ata, ! rei'i0e/
EE
Cauz# '# )a% f('!-$ %)p#%'a$ %- apa(%$%a u#'(u#u% /a+$(%' +% *u"*-a#
+u-$3
E2
in#etia $a"tria ! bateria 1#%'",a'$( p2#"(%
on"!&!l 'e a-$%%f#a)a$"(%% $en A"%irina, In'o&etain, Ib!%ro#en, Dilo#ena,
in a"oiere "a! n! ! %re%aratele ortizonie "i antia$re$antele %la1etare
6Pla0i49"a! antioa$!lantele 6Tro&bo"to%9/
Ae"te a!ze, a"oiate !n!i teren $eneti e %re'i"%!ne "i !nor #atori
#a0orizanti a #!&at!l, alool!l, iroza 1e%atia, bolile %!l&onare "e0ere "a!
in"!#iienta renala ronia, '! la !ler/
De obiei, !ler!l %ro'!" %rin Feliobater a%are la '!o'en 'ar a"oiaza "i o
$a"trita ronia, rei'i0ele #iin' #re0ente 'ar n! %rea '!e la o&%liatii/
Di&%otri0a, !ler!l %ro'!" 'e antiin#la&atorii a%are la "to&a, a"oiaza "i el o
$a"trita ronia, #re0ent n! 'eter&ina nii !n "i&%to& "i e"te 'ia$no"tiat 'oar
an' a%ar o&%liatiile 61e&ora$ia9, $ra0e la 0ar"tni/ N! &ai rea%are 'aa "e
intrer!%e on"!&!l 'e antiin#la&atorii/
De"i$!r, !na 'in a!ze n! o e4l!'e %e ealalata 6%ot #i %rezente a&bele9/
Pe lan$a %lenit!'ine, "atietate %reoe, (ena in a%!l %ie%t!l!i, "i&%to&!l "%ei#i
bolii !leroa"e e"te re%rezentat 'e '!rerea 0ie e a%are la 2,+ ore '!%a &e"e, in
a%!l %ie%t!l!i, al&ata 'e in$e"tia 'e ali&ente "a! %rotetoare $a"trie, 'ar are
e"te %rezenta "i noa%tea, trezin' %aient!l 'in "o&n/
E%i"oa'ele '!reroa"e tin E,2 "a%ta&ani "i "!nt 'eter&inate 'e rein#etia !
Feliobater, 'e #!&at, on"!& 'e alool "a! antiin#la&atorii/ D+% + '(*a 'a
+$(++u# *u' #a u#'(3 a'+$a *$()%-a *"a( $u#,u(a(% fu-'$%"-a#/ La
%er"oanele &ai in 0ar"ta e %o"ibil a !ler!l "a n! 'eter&ine nii !n "i&%to& "i "a
reia"a a a! aea"ta boala at!ni an' 0ar"a ! "an$e "a! a! "a!n ne$r! a %a!ra
6&elena9/
D%a/-"+$%'u# +$ pu+ '# )a% 4a'$ p(%- -*"+'"p% *"a(' "(%'
)"*%f%'a(3 %-'#u+%! u#'(3 #a -%!#u# +$")a'u#u% $(,u% ,%"p+a$a p-$(u a
E+
4'#u* u- 'a-'( /a+$(%' #a *,u$ +% p-$(u a pu- %- !%*-$a 'u '($%$u*%-
p(z-$a 1#%'",a'$(u#u%.
Daa n! a0e& la 'i"%ozitie en'o"o%ia "a! %aient!l e"te in 0ar"ta ! boli
ar'iae "a! %!l&onare $ra0e, "e 0a #ae tranzit!l baritat 6in$1itirea 'e bari! !
e#et!area !nor li"ee ra'iolo$ie9/ Ca orie "e$&ent al t!b!l!i 'i$e"ti0 6e"o#a$,
"to&a, '!o'en, (e(!n, ileon, olon9, !ler!l n! "e 0e'e la eo$ra#ia ab'o&inala/
E4i"ta ni"te "e&ne in'irete are "!$ereaza %o"ibila %rezenta a !n!i !ler, 'ar
'ia$no"ti!l 'e ertit!'ine "e %!ne 'oar %rin en'o"o%ie/
C")p#%'a$%%# u#'(u#u%3
hemoragia digestiva , a%are &ai #re0ent la 0ar"tni!l on"!&ator 'e
antii#la&atorii %entr! boli ar'iae "a! re!&atolo$ie/ Se &ani#e"ta a 0ar"at!ra !
"an$e 'e obiei ne$r! , a !n zat 'e a#ea 'ar %oate #i "i ro"! %roa"%at "a! !
1ea$!ri 'e "an$e "a! a "a!n ne$r! l!io" 6&elena9/
Rp(z%-$a " u(/-$a3 pa'%-$u# $(,u%-* a*u+ #a +p%$a# 5/a+$("-$("#"/67
Trata&ent!l %oate #i ! %rotetor $a"tri "a! 1iar %rin o%rirea 1e&ora$iei %rin
en'o"o%ie 6in(etare 'e alool "a! a'renalina in rater!l !lero"9/ Uneori e"te
ne0oie 'e 1ir!r$ie 'e !r$enta in az!l 1e&ora$iilor "e0ere/ De aeea e"te nee"ar
"a a"oie& !n %rotetor $a"tri ti% Fa&oti'ina "a! .&e%razol inainte 'e a l!a
antiin#la&ator!l, &ai ale" 'aa ae"ta treb!ie a'&ini"trat %e o %erioa'a l!n$a 'e
ti&%/
p(f"(a$%a e"te "i ea &ai #re0enta la 0ar"tniii on"!&atori 'e
antiin#la&atorii 'eoaree %e &!oa"a $a"tri #ra$ila a%are !n !ler a'an ! "an"e
'e a %er#ora %eretele ! %eritonita !lterioara/ Daa '!rerea !leroa"a 'e0ine br!"
#oarte inten"a a"t#el inat %aient!l "ta ne&i"at, e %ali', tran"%irat, n! "!%orta
ni&i %e b!rta %oate a0ea !ler %e#orat "i $(,u% a*u+ * u(/-$ #a +p%$a#
5'8%(u(/%67 !ler!l '!o'enal ! e0ol!tie in'el!n$ata %oate '!e !neori la
in$!"tarea %ilor!l!i/
E7
+$-"za p%#"(%'a , ! "a'ere in $re!tate, 0ar"at!ri ! ali&ente %artial
'i$erate 6%aient!l re!noa"te &anarea in$erata ! ate0a zile in !r&a9/ Se %oate
inera 'ilatare en'o"o%ia at!ni an' %aient!l n! "!%orta inter0entia
1ir!r$iala/
Ap-*%'%$a a'u$ f#/)"-"a+9/a-/(-"a+ p(f"(a$3 '")p#%'a$ 'u
p(%$"-%$
AeAti %aien@i "e interneaz> '!%> 27,)2 ore 'e la 'eb!t, 'in a!za a're">rii
?ntCrziate a bolna0!l!i "a! a $reAelilor 'e 'ia$no"ti/ In#la&a@ia 'i"tr!ti0> Ai
%er#ora@ia a%en'iel!i "e %ot 'elanAa Ai la bolna0ii "%italiza@i ?n "e@ia 1ir!r$ie
"a! ?n alte "e@ii 'in a!za 'ia$no"ti!l!i inert Ai "!%!Ai ti&% ?n'el!n$at
ob"er0a@iei #>r> #olo"irea o%ort!n> a &eto'elor %aralinie 'e 'ia$no"ti nee"are
6eo$ra#ia, la%aro"o%ia9/
Spitalizarea transferarea! ?n "e@ia 1ir!r$ieGreani&are a ori>r!i "%ital
are aor'> a"i"ten@a 1ir!r$ial> 'e !r$en@>, e"te obli$atorie/ Dn az 'e a%en'iit>
a!t>, o&%liat> ! %eritonita 'i#!z> "e reo&an'> "%italizarea 6tran"#erarea9
!r$ent> ?n "e@ia 1ir!r$ieGreani&are a !n!i "%ital interraional, &!nii%al
E<
"iagnosticul +e "tabileAte ! ertit!'ine %e baza o&%lia@iei a%en'iitei
'i"tr!ti0e3 %eritonit> loalizat>, %la"tron a%en'i!lar "a! %eritonit> 'i#!z>/
F%/ : P%+a "p(a$"(%: #a +';%"-a(a ap-*%'#u% /a-/(-a$ + /++' <
'"-'(;%u-% 'u *%a)$(u# * : ').3 +%$ua$ #a #%)%$a p"(;%u-%% /a-/(-"a+
5+$('"#%$6.
F%/ < A+p'$ %-$(a"p(a$"(: 5ap-*%''$")%6 #z%u-% %-f#a)a$"(%% =%
/a-/(-"a+ .- >u)$a$a *%+$a# a ap-*%'#u%.
E=
Dia$no"ti!l a%en'iitei a!te o&%liate ! %eritonit> loalizat>/
Ana&neza Ai "i&%to&ele ini@iale ale a%en'iitei ore"%!n' #or&ei o&!ne 'ar ! o
&ani#e"tare lini> nelar> "a! on#!z> %Cn> la &o&ent!l o&%lia@iei, Cn' a%ar
"e&nele %rini%ale 'e %eritonit>/ Se %ro'!e e#acer$area durerii somatice
spontane, !r&at> 'e 0>r">t!ri re%etate/
E4a&inarea obieti0> 'eeleaz>3 %ozi@ia antal$i> ?n 'e!bit 'or"al "a! lateral
're%t ! oa%"a 'rea%t> #letat>, #aie"!l %aient!l!i e"te on$e"tionat e4%ri&Cn' o
&are "!#erin@>, "e&ne 'e 'e"1i'ratare e4trael!lar> ! li&b> "ab!ral>, !"at>/
Semnele generale araterizeaz> "tarea "e%ti>3 temperatura 6+B,+*,<HC9,
tahicardie 6%!l" IE::G&in9 Ai hipotensiune arterial 6JE:: &&F$9/ Micrile i
tusea exacerbeaz durerea spontan.
%espiraia a$dominal este diminuat la ni0el!l ab'o&en!l!i 're%t/
Pal%area re$i!nii iliae 're%te e0i'en@iaz> "i&%to&ele %rini%ale3 '!rere,
ontrat!r> &!"!lar>, "e&ne 'e irita@ie %eritoneal> %oziti0e 6-l!&ber$, Man'ell
et/9/
T!Ae!l retal G 0a$inal e"te '!rero"/
E4%lor>rile %aralinie e0i'en@iaz> le!oitoz> i&%ortant> 6%e"te EB:::,
2::::G&&+9/
E)
Dia$no"ti!l a%en'iitei a!te o&%liate ! %eritonit> 'i#!z> 6$eneralizat>9
S!nt !no"!te trei &eani"&e 'e 'ez0oltare a %eritonitei a%en'i!lare 'i#!ze3
a9 Peritonita $eneralizat> K%ri&ar> "e %oate %ro'!e '!%> !n inter0al 'e
iraE,2 zile 'e la 'eb!t!l lini al a%en'iitei a!te/ D!rerea e"te e4aerbat> Ai
'i#!z>L 'e a"e&enea, ontrat!ra &!"!lar> "e $eneralizeaz> Ai "e o%reAte tranzit!l
inte"tinal/ Se altereaz> "tarea $eneral>, #ebra 'e0ine "e%ti> ! le!oitoz>
M2::::G&&+ Ai ne!tro#ilie/ Se %oate in"tala
"e%"i"!l "e0er/
b9 Peritonita 'i#!z> 'ez0oltat> ?n 'oi ti&%i, Cn' '!%> %eritonita ini@ial>
loal> 6ti&%!l ?ntCi9 "e %ro'!e o a&eliorare "%ontan> %rin trata&ent &e'ial,
!r&at> '!%> !n inter0al 'e ore "a! zile 'e $eneralizarea %roe"!l!i %eritoniti
6ti&%!l al 'oilea9/
9 Peritonita $eneralizat> ?n trei ti&%i %rezint> !r&>toarele eta%e e0ol!ti0e3
a%en'iita ini@ial> ! %eritonit> loal> la %aien@ii are "e "%italizeaz> '!%> 27,)2
ore 'e la 'eb!t!l rizei 6ti&%!l ?ntCi9, !r&at> 'e #or&area %la"tron!l!i 6ti&%!l al
'oilea9, !r&at> a%oi 'e abe'area %la"tron!l!i Ai r!%erea abe"!l!i ?n &area
a0itate %eritoneal> 6ti&%!l al treilea9/
"iagnosticul peritonitei apendiculare difuze "e bazeaz> %e aeleaAi "e&ne
a Ai ale %eritonitei a%en'i!lare loale, 'ar ! o stare general i intoxicaie mai
grav 6!neori "e%"i" "e0er9 Ai ! diseminarea rapid sau treptat a simptomelor
peritoneale durerea somatic, contractura muscular i ileusul paralitic! a"!%ra
?ntre$!l!i ab'o&en/

S%-*(")u# * %-$+$%- %(%$a,%#
Con"tit!ie in zilele noa"tre !na 'in ele &ai #re0ente %atolo$ii
$a"trointe"tinale, a!zata in %rini%al 'e "tre""!l oti'ian/ Uneori a%are '!%a o
in#etie 0irala "a! bateriana inte"tinala/
EB
Dia$no"ti!l ae"t!i "in'ro& e"te %rin e4l!'erea altor boli e %ot 'eter&ina
aelea"i "i&%to&e ! ae"ta/
De obiei %aientii "!nt an4io"i, %rezinta "enzatia 'e NOno' in $atNO, "e te& a
a! o boala $ra0a "i "e %lan$ 'e3
on"ti%atie "a! 'iaree "a! alternanta elor 'o!a
balonari "i bolboro"eli in b!rta
'!reri in tot ab'o&en!l "a! 'ea"!%ra %!bi"!l!i
Con"ti%atia in"ea&na "a!n tare, eli&inat ! e#ort "a! !n "a!n e0a!at la
&ai &!lt 'e 2 zile/ In inte"tin!l iritabil "e %oate e0i'entia "an$e ro"! la "#ar"it!l
"a!n!l!i %rin %rezenta ono&itenta a 1e&oroizilor/ Deoaree #re0ent in aae"ta
a#eti!ne &i"arile olon!l!i "!nt inten"e, &ateriile #eale "e %ot #ra$&enta in
!r"!l %roe"!l!i 'e e0a!are a lor, a"t#el inat "a!n!l "a aibe a"%et 'e reion,
%an$lia "a! NOaareze 'e oaieNO/ De notat a ae"t a"%et %arti!lar %oate a%are "i
in aner!l 'e ret, an' 'atorita t!&orii are "e 'ez0olta in interior!l inte"tin!l!i,
#ealele n! &ai a! %rea &!lt lo 'e treere "i at!ni "e eli&ina "!b #or&a 'e
%an$lia "!btira "a! reion/ Pentr! a #ae 'i#erenta 'intre ele 'o!a a#eti!ni,
treb!ie on"!ltat &e'i!l "%eiali"t/
De"i$!r a 'aa "!nte& 'ia$no"tiati ! "in'ro& 'e inte"tin iritabil %!te&
#ae la !n &o&ent 'at "i 'a-'( '"#"0('$a# 5u-a *%- )a-%f+$a(%# a'+$u%a +$
#%)%-a(a * +'au- 'u +a-/6 #ara a ele 'o!a a#eti!ni "a aibe 0reo le$at!ra
!na ! ealalta/
De aeea e obli$atori! e#et!area '"#"-"+'"p%%, &ai ale" '!%a 7:,<: ani
"a! 'aa a%ar "i&%to&e "e0ere 6"an$e in "a!n, "a'ere in $re!tate &are, '!reri
ab'o&inale i&%ortante9/
E*
COLONOSCOPIA
Diareea e"te 'e obiei e4%lozi0a, %aient!l treb!in' "a #!$a la toaleta, !
&!lte $aze, !neori ! #ra$&ente 'e ali&ente ne'i$erate/ N!&i& 'iaree eli&inarea
a &ai &!lt 'e + "a!ne in 27 ore/ De &!lte ori %aientii 'e"ri! eli&inarea a 2,+
"a!ne 'i&ineata, !lterior ne&aia0an' nii !n "a!n %e %ar!r"!l zilei/
Va treb!i e#et!ata o%ro!lt!ra "i o%ro%arazitolo$ia %entr! e4l!'erea !nei
in#etii inte"tinale/, 1or&onii tiroi'ieni 'eoaree 1i%ertiroi'ia e0ol!eaza ! 'iaree
"i olono"o%ia %entr! e#cluderea polipilor sau a cancerului colo rectal/
2:
Diareea 'in "in'ro&!l 'e inte"tin iritabil n! 0a ontine niio'ata "an$e,
'eat in az!l 1e&oroizilor iritati 'e "a!nele ai'e "i nii n! a%are noa%tea, 'eat
#oarte rar/
2E
S%-*(")u# * %-$+$%- %(%$a,%# -u a( '")p#%'a$%% +% -u !"#uaza
-%'%"*a$a #a 'a-'( '"#"0('$a#7
T(a$a)-$u# '"-+$a %- 3
re$i& a'a%tat "it!atiei 6on"ti%atie "a! 'iaree9
&e'ia&ente %entr! re$larea &i"arilor inte"tinale, %entr! ab"orbtia $az!l!i
%re!& "i an4iolitie %entr! 'i&in!area "tre""!l!i/
C"#'%+$%$a a'u$a
Poate e0ol!a "%re re$re"ie 6"!b antibiotera%ieG"%ontan , rarL'e0ine olei"tita
ronia "e1elara ! %eriolei"tita ! ten'inta la rea!tizare9, "%re %er#oratie 6in
blo!l "!b1e%ati "a!G"i in %eritone!l liber , in %ri&ele 7B 1 'e olei"titaa!ta, la
batraniG%aienti ! reati0itate "laba, 'eter&inan' %eritonita biliara, #or&a "e0era,
&ortalitate 7:;9, "a! "%re #i"t!lizare 6or$an a0itar in0einat #i"t!la olei"to
22
'!o'enalaGolia/ Drenarea ontin!t!l!i 0ezi!lar in l!&en 'eter&ina a&eliorarea
"i&%to&atolo$iei "i a "tarii $enerale9/ Tratamentul este chirurgical.
Mo&ent!l o%erator e"te 'ei"i0/ Peritonita biliara 'i#!za "e o%ereaza in
!r$enta &a4i&a,%ratian'!,"e olei"teto&ie "i trata&ent!l %eritoniteiL
olei"tita a!ta "e %oate o%eraOla al'O , 27,)2 1 'e la 'eb!t , in !r$enta i&e'iata
"a! in !r$enta intarziata #iin' te&%orizata "!b re%ao" #iziGali&entar "i trata&ent
&e'ia&ento" 6antibioti,antiin#la&ator, antal$i9 "i %!n$a ! $1eata loal/
Neo%la"&!l 'e 0ezia biliara %oate a%area la 0e1ii litiazii, &ai &!lt 'e B,
E:;'in az!ri 6*:; 'in az!rile ! ae"t ti% 'e neo%la"& a%ar %e teren litiazi, la
%aienti 'e %e"te =: ani9/ Fi"to%atolo$i e"te !n a'enoarino& a$re"i0 are
in0a'eaza ra%i' %at!l 1e%ati "i or$anele 0eine 6olon, '!o'en, alea biliara
%rini%ala9, &eta"tazan' in no'!lii %e'i!l!l!i 1e%ati 6%ro'!e iter %rin
o&%re"i!ne9 "i in lobii 1e%atii , #re0ent/
C.MPLICATII , #re0ente, %!tan' #i inte"tinale "i e4tra,inte"tinale3
I. C")p#%'a$%% %-$+$%-a#:
2+
:. P(f"(a$% %- 'a!%$a$a p(%$"-a#a3 e"te o o&%liatie rara "i $ra0a e in'ia
trata,&ent 1ir!r$ial 'e !r$enta/
<. A,'*a(: a%are #re0ent, "e'i!l %!tan' #i interileal, intra&ezenteri,
retro%eritoneal "a! ileo%arietal/
?. F%+$u#%za(3
a9 #i"t!le entero,enterale3 a%ar la P 'in %aienti in !r"!l e0ol!tiei boliiL re%rezinta
o o&!niare anor&ala intre 'o!a an"e ileale "a! intre o an"a ileala "i olonL
#i"t!lele &ii n! %ro'! &o'i#iari notabile ale "tarii $eneraleL #i"t!lele lar$i, are
"ot 'in tranzit !n "e$&ent l!n$ 'i$e"ti0, nee"ita trata&ent 1ir!r$ialL
b9 #i"t!lele entero,0eziale3 re%rezinta o o&%liatie $ra0aL %ro0oaa in#etie
!rinara, %ne!&at!rie "a! #eal!rieL
9 #i"t!le entero,$enitale3 %ot #i entero,t!bare, entero,0a$inale, rar entero,!terineL
'9 #i"t!le e4terne3 "!nt o&%liatii "e0ereL realizeaza o&!niari intre inte"tin "i
%ere,tele ab'o&inal, re"%eti0 intre ret "i re$i!nea %erianala "a! 0!l0a/
@. O,+$(u'$% %-$+$%-a#a3 in "ta'iile initiale a%are "e!n'ar e'e&!l!i "i "%a"&!l!i,
!lterior a%aran' "tenoze or$anieL lini "e &ani#e"ta %rin '!reri oliati0e inten"e,
0ar"at!ri, %eri"taltia re"!ta ! z$o&ote 1i'roaerie, ab"enta a tranzit!l!i %entr!
#eale "i $aze/
A. Ma#%/-%za(3 boala Cro1n re%rezinta o "tare %reaneroa"aL ri"!l 'e
&ali$nizare e"te re"!t in "e$&entele inte"tinale e4l!"e %rin bQ,%a""/
II. C")p#%'a$%% 4$(a%-$+$%-a#:
:. S%-*(") * )a#a,+"(,$%3 "e &ani#e"ta %rin "teatoree "i ane&ieL "!nt a#etate
ab"orbtia li%i'elor "i a 0it/-E2L %oate a%are in a#etari intin"e "a! '!%a rezetia
ileala/
<. D%a(3 "!r0ine "e!n'ar 'e#iit!l!i 'e reab"orbtie ileala a aizilor biliari, !
"ti&!lare a "eretiei olonie/
?. E4a'(,a( a f#"(% %-$+$%-a#3 "!r0ine on"e!ti0 "tazei %ro4i&al 'e zonele
'e "tenoza "a! 'atorita reir!larii ontin!t!l!i inte"tinal %rin #i"t!lele "%ontane
"a! ana"to&ozele 1ir!r$iale/
27
@. L%$%aza ,%#%a(a3 "!r0ine on"e!ti0 %ier'erii 'e aizi biliari, ! re"tere a
lito$eniitatii bilei/
A. A#$(a( a fu-'$%% 8pa$%'3 "e &ani#e"ta #re0ent %rin "teatoza "a! a&iloi'oza
1e%atiaL !neori "e %oate a"oia olan$ita "lerozanta %ri&iti0a/
B. O+$"p"("za +% "+$")a#a'%3 a%ar on"e!ti0 &alab"orbtiei ali!l!i, 0it/D "i
arentei %roteie/
C. C")p#%'a$%% u(%-a(3
, litiaza renala 6%rin t!lb!rari ale &etaboli"&!l!i ali!l!i9L
, 1i'rone#roza "i 'ilatare !reterala 6%rin in#la&atie retro%eritoneala9L
, #i"t!lizare ileo,0ezialaL
, a&iloi'oza renala 6!r&are a %roe"!l!i in#la&ator 'e '!rata9/
D. C")p#%'a$%% a($%'u#a(3
, artral$ii "a! artrita %a"a$era 6in"ote" la R 'in %aienti e%i"oa'ele 'e a!tizare
inte"tinala9L
, "%on'ilita anSilo%oietia 6a%are la EGE: 'in %aienti, an!&e la ei ! anti$en 'e
1i"too&%atibilitate FLA,-2) %rezent9/
E. C")p#%'a$%% *()a$"#"/%'3 erite& no'o", 'er&atita e4#oliati0a, %Qo'er&a
$an$reno"!&, "in'ro& Ste0en",To1n"on/
:F. C")p#%'a$%% "f$a#)"#"/%'3 on(!nti0ita, e%i"lerita, irita, !0eita/
::. U#'( af$"a+ ,u'a#
/
2<
CAPITOL IV
FIZIOPATOLOGIE
Peritonita a!t> 'i#!z> rez!lt> 'in rea@ia loal> a %eritone!l!i Ai a 0i"erelor
ab'o&inale Ai ea $eneral> a ?ntre$!l!i or$ani"& la a@i!nea a$re"i0> a $er&enilor
&irobieni Ai a !nor %ro'!Ai ?n %eritone!/
Fa'$"(%% * a/(+%u- +u-$ (p(z-$a;% *:
#lora &irobian> ! alit>@ile "ale 'e 0ir!len@>, 0iteza 'e ?n&!l@ire,
%!tere nerozat>, to4iitate 6e4oto4ine, en'oto4ine9L "!nt &ai a$re"i0i $er&enii
anaerobi/
%ro'!Ai biolo$ii3 li1i' $a"tri, bil>, "! inte"tinal, "! %anreati,
li1i' oli/
Ra';%%# p(%$"-u#u% +u-$ * $%p %-f#a)a$"(:
"ere@ia "erole!oitar> %!r!lent> ?n %ri&a #az> ?n"o@it> 'e e'e&,
1i%ere&ie Ai in#iltra@ie e'e&oa"> a t!t!ror 0i"erelor, e%i%loanelor Ai &ezo!rilor,
"e!n'ar in#la&a@iei %eretel!i inte"tinal a%are ile!"!l 'ina&i/
e4!'at &!o,"e%ti ?n a 'o!a #az>, are are ten'in@a "> ?n1i"teze "ere@ia
%!r!lent> 'in %eritone! ?n 'i0er"e lo(e3 a'eren@ele #ibrinoa"e realizeaz> !neori o
0eritabil> ol!zie &eani>/
/

2=
CAPITOL V
SIMPTOMATOLOGIE
A! #o"t 'e"ri"e3
S)- fu-';%"-a#
Du((a e"te %ri&!l "e&n are a%are ?ntr,o %eritonit> a!t>/ Treb!ie
%reizate3 &o'alitatea 'e 'eb!t 6br!tal> "a! n!9, "e'i! 6loalizat> "a! 'i#!z>9,
e0ol!@ia, ira'ierea, %aro4i"&ele/ Toate ae"te ele&ente a! i&%ortan@> ?n
'ia$no"ti!l etiolo$i al %eritonitei/ D!rerea e"te 'e obiei br!tal>, ?n %er#ora@ie/
Poate #i ini@ial loalizat>, 'i#!zCn' ?ntr,o eta%> !lterioar>, "a! %oate #i 'e la ?ne%!t
'i#!z>/ Ea %oate #i ontin!> Ai "tabil> "a! ! e4aerb>ri %aro4i"tie/ Poate ira'ia ?n
lo!ri 'i#erite 61i%o$a"tr!, 'e "a Do!$lo", !&>r, re$i!nea "a%!lar>9 'e inten"itate
'i#erit>, 'e la lo0it!ra 'e %!&nal a in!n'a@iei %eritoniale %Cn> la #or&ele aten!ate/
V(+$u(%# #re0ente "a! biliare %ot ontrib!i, at!ni Cn' "!nt ab!n'ente
la 'ez1i'ratarea bolna0!l!i/
Op(%(a $(a-z%$u#u% %-$+$%-a# %entr! &aterii #eale Ai $aze %ro'!" ini@ial
%rin ile!" 'ina&i re#le4, !lterior %oate @ine 'e "!%raa'>!$area !nei ol!zii
&eanie/ Dn %eritonitele 1i%erto4ie "e %oate ?ntClni 'iareea/
Su/8%;u# ?ntClnit inon"tant, e"te e4%re"ia irita@iei 'ia#ra$&!l!i, a "tazei
$a"trie Ai a "t>rii to4ie/
S)-# f%z%' a,*")%-a# "!nt #>r> 0aloare %entr! %reizarea
'ia$no"ti!l!i/ Cel &ai 'e" "e&n e"te neontratarea %eretel!i ab'o&inal,
are "e %oate %!ne ?n e0i'en@> %rin3
I-+p';%a ab'o&en!l!i are arat>3
, i&obilizarea %eretel!i ab'o&inal ?n ti&%!l re"%ira@iei/
, re"%ira@ia e"te "!%er#iial>, &ai #re0ent> 'e ti% torai "!%erior/
2)
Pa#pa(a ab'o&en!l!i e"te ti&%!l el &ai i&%ortant al e4a&en!l!i #izi Ai
rele0>3
, ontratarea ab'o&inal> re%rezint> reAterea ton!"!l!i &!"!lat!rii
%ere@ilor, "e!n'ar %eritonitei/ Peretele ab'o&inal n! "e la"> 'elo 'e%ri&at %rin
a%>"are, &ane0ra #iin' e4tre& 'e '!reroa">/
, a%>"area &!"!lar> e"te !n "e&n &ai %reoe al %eritonitelor/ Peretele
ab'o&inal ! ton!" nor&al "e la"> ini@ial 'e%ri&at %entr! a bolna0!l "> "i&t>
'!rerea Ai "> ontrateze %eretele/
, '!rere la 'eo&%ri&area br!"> a %eretel!i ab'o&inal '!%> o a%>"are
%ro$re"i0> 6"e&n!l -l!&ber$9/
, 1i%ere"tezia !tanat> on"t> ?n %ro'!erea !nei "enza@ii %arti!lare
'!reroa"e at!ni Cn' "e %al%eaz> te$!&entele %eretel!i ab'o&inal ?n zona
or$an!l!i a#etat/
P('u;%a ab'o&en!l!i %oate ar>ta3
, %er!@ia '!reroa"> a ab'o&en!l!i , U"e&n!l lo%o@el!l!i 6Man'el9
'i"%ari@ia &atit>@ii 1e%atie 6"e&ne 'e %ne!&o%eritone!9
A+'u#$a;%a ab'o&en!l!i %!ne ?n e0i'en@> o liniAte ab"ol!t> 6"e&n 'e
%arez> inte"tinal>9/
Tu=u# ('$a# Ai $u=u# !a/%-a# %ro0oa> o '!rere 0ie la a%>"area
#!n'!l!i 'e "a Do!$la" 6@i%>t!l Do!$la",!l!i9 "a! bo&barea Do!$la",!l!i are
erti#i> %rezen@a re0>r"at!l!i %eritonial/
S)- '#%-%' /-(a# a! o 0aloare &ai &!lt a%reiati0> a"!%ra
"t>rii $enerale a bolna0!l!i are %oate %rezenta3
C(=$(a $)p(a$u(%% +B,<VC, +*VC are %oate li%"i ?n %ri&ele ore/
Pu#+u# %oate #i nor&al "a! aelerat onor'at ! reAterea ter&i>/ Li%"a 'e
onor'an@> 'intre %!l" Ai te&%erat!r> on"tit!ie !n in'ie %re@io" 'e a%reiere a
$ra0it>@ii !nei %eritonite/
2B
T-+%u-a a($(%a# ini@ial nor&al>, "a'e %Cn> Cn' "e in"taleaz> "tarea
'e Ao/
S$a(a /-(a#: -olna0!l e"te %ali', Ai a'e"ea ?i e"te arateri"ti U#aie"!l
"!#erin', a$itat, tran"%irat, ?n"%>i&Cntat !no"!t "!b n!&ele 'e #ai"
%eritoneal/
Fai"!l!i %eritoneal ?i "!nt arateri"tie Ai !r&>toarele3 o1ii ?ner>na@i,
?n#!n'a@i ?n orbite, l!ioAi, an4ioAi, lenze ar"e, te$!&ente teroa"e 6%>&Cntii9/
E4a)- pa(a'#%-%'
E4a)- * #a,"(a$"(
a&ilaza Ai li%aza "!nt &o'erat re"!te ?n $eneralL
$lie&ia reAte ?n ai'oza 'iabeti> Ai ?n %anreatit>L
!reea reAte ?n "t>ri 'e 'ez1i'ratareL
le!oitoza e"te #re0ent ?ntClnit> Ai %rezint> !neori 0alori &ariL
ane&ia obiAn!it>L
eletroene#alo$ra&a e"te nee"ar> %entr! eli&inarea 'ia$no"ti!l!i 'e
in#art &ioar'i/
E4a)-u# (a*%"#"/%' p /"# %oate e0i'en@ia %ne!&o%eritone!l "!b #or&> 'e
i&a$ini lare, "e&il!nare, "it!ate "!b 'ia#ra$&>, i&a$ini 1i'roaerie ?n ol!zia
inte"tinal>, al!li biliari "a! !rinari ra'ioo%ai, !&bra !n!i abe" "a! a !nei &a"e
t!&orale/
Pentr! 'ia$no"ti "!nt !tile Ai %!n@ia ab'o&inal> %re!& Ai %eritoneo"o%ia/
Se %!n@ioneaz> ?n zona &at> Ai 'a> "e e4tra$e li1i' "e on#ir&> %eritonit> 6?n
&o' nor&al n! "e e4tra$e li1i' 'in a0itatea %eritoneal>9/
Pu-';%a a,*")%-a# +au pa(a'-$za re%rezint> tra0er"area %eretel!i
ab'o&inal Ai %>tr!n'erea ?n a0itatea ab'o&inal> ! a(!tor!l !n!i troar/
Se #ae ?n "o% e4%lorator Ai tera%e!ti/
2*
Ma$(%a#u# -'+a( p-$(u f'$ua(a pa(a'-$z%3
&a"> ao%erit> ! !n C&% "terilL
a"olet> ! C&%!ri "terileL
a"olet> ! &>n!Ai "terileL
a"olet> ! troar $ro" ! 'ia&/ 'e +,7 &&L
&!Aa&a Ai tra0er"> "!b bolna0L
!n 0a" $ra'at %entr! oletarea li1i'!l!iL
!n earAa# ?&%>t!rit ?n trei, aAezat ?n re$i!nea lo&bar>, %entr! ban'a(area
ab'o&en!l!i ?n ti&% Ai '!%> e0a!area li1i'!l!iL
t>0i@> renal>L
"erin$i 'e 2,< &l "terileL
aeL
"ol!@ie %entr! 'ezin#e@ia lo!l!i 'e ele@ie 6alool, tint!r> 'e io', alool
io'at9L
no0oain> %entr! ane"tezie loal>L
a"olet> &i> ! o&%re"e "terileL
'o!> e%r!bete "terile 6a"t!%ate9 eti1etateL
"!b"tan@e nee"are %entr! rea@ia RIVALTAL
+:
ae 'e "i$!ran@>L
atetere "terile %entr! e0a!area 0eziii !rinare Cn' bolna0!l %rezint>
t!lb!r>ri 'e &i@i!ne/
Dntre$!l in"tr!&entar "e %re$>teAte %e o &>"!@> ao%erit> ! !n C&% "teril Ai
"e a'!e ?n a&er> n!&ai ?n !lti&!l &o&ent %entr! a n! a!za "t>ri 'e neliniAte
bolna0!l!i/ Ma"a ! in"tr!&ente "e aAeaz> Ct &ai a%roa%e 'e bolna0/
P!n@ia "e realizeaz> la %at!l bolna0!l!i '!%> e a %rote(at %at!l ! !n
%ara0an/ Dnainte 'e %!n@ie bolna0!l 0a #i %ozi@ionat ?n 'e!bit 'or"al ! tr!n1i!l
!Aor ri'iat/
R"#u# a+%+$-$% .- $%)pu# pu-';%%
A"i"tenta 0a reolta %robele "terile 'e li1i' o antitate 'e E::,2:: &l %entr!
laborator 6'!%> e &e'i!l retra$e &an'ren!l9 e4a&en itolo$i, 'eter&inarea
antitati0> 'e alb!&in>/
Se a%li> t!b!l 'e a!i! ?n %rel!n$irea an!lei Ai "e oleteaz> li1i'!lo
ai"ti ?n rei%ient!l %re$>tit %entr! ae"ta/
Se ob"er0> "tarea $eneral> a bolna0!l!i Ai "e &>"oar> %!l"!l Ai re"%ira@ia
'a> a%ar o&%lia@ii "e an!n@> i&e'iat &e'i!l/
Partea "!%erioar> a ab'o&en!l!i "e ba'i(oneaz> ! earAa#!l ?&%>t!rit
6%entr! a 'e%ri&area a0it>@ii ab'o&inale "> "e #a> br!"9 Ai "e "trCn$e %ro$re"i0/
Se "!%ra0e$1eaz> 0iteza 'e e0a!are 6n! treb!ie "> #ie &ai &are 'e !n litr! la E<
&in9/ La %ri&a %araentez> "e e0a!eaz> n!&ai 7,< litri 'e li1i'/ Li1i'!l "e
e0a!eaz> ?n ti&% 'e E,2 ore/
Se "1i&b> %ozi@ia bolna0!l!i, ?n 'i#erite 'ire@ii 6'a> ?n ti&%!l e0a!>rii
"!r$erea "e o%reAte br!"9/
Se intro'!e &en'ren!l nea"!@it ?n troar 6Cn' ori#ii!l ae"t!ia "e ao%er>
! o an"> inte"tinal> "a! #laoane 'e #ibrin>/9
+E
Se ba'i(oneaz> lo!l %!n@iei ! tint!r> 'e io' '!%> e &e'i!l e4tra$e
troar!l/
Se a%li> !n %an"a&ent "teril/
Se "trCn$e earAa#!l ?n (!r!l ab'o&en!l!i Ai "e #i4eaz> ! ae 'e "i$!ran@>/
A''%*-$
Dn !r&a 0a"o'ilata@iei e4e"i0e %rin 'eo&%ri&area br!"> a a0it>@ii
ab'o&inale bolna0!l %oate #ae ola%"/ Dn ae"t az &e'i!l 0a ?ntrer!%e %!n@ia Ai
"e 0or a'&ini"tra bolna0!l!i "!b"tan@e anale%tie "e %oate in"tala o 1e&ora$ie
intern>/
CAPITOL VI
DIAGNOSTICUL DIFERENIAL
Ae"ta "e #ae !3
Af';%u-% )*%'a# 'u +%)p$")a$"#"/% a,*")%-a#
oli> renal>
oli> 1e%ati>
!ler ?n %!"e! e0ol!ti0
in#art!l &ioar'i
%ne!&o%atii bazale
Af';%u-% '8%(u(/%'a#
ol!zii inte"tinale
%anreatit> a!t>
in#art!l entero&ezentri
"arina e4tra!terin> r!%t>
D%a/-"+$%'u# *%f(-$%a#
+2
Se #ae ! n!&eroa"e a#eti!ni intraab'o&inale are "e on#!n'a ! o
%eritonita/ In ae"t az ele nee"ita aeea"i "anti!ne, inter0entia 1ir!r$iala 'e
!r$enta, iar 'ia$no"ti!l 0a #i "tabilit intrao%erator/ . eroare 'e 'ia$no"ti !
a#eti!ni ne1ir!r$iale %oate '!e la o inter0entie 1i,r!r$ilaa in!tila, 1iar
'a!natoare/In a'r!l ab'o&en!l!i a!t &e'ial %eritonitele "e %ot on#!n'a !
oliile ab'o&inale3 1e%atia, renala, "al%in$iana, etia, "at!rnina/
Loalizarea '!rerii, ira'ierea, a"oierea "e&nelor "%ei#ie bolii "i ab"enta
ontrat!rii ab'o&inale, le %ot 'i#erentia/
Colia biliara 'in 'i"Sineziile biliare "i olei"tita a!ta, ! loalizare ti%ia in
1i%oon'r!l 're%t "i ira'iere la baza 1e&itorael!i 're%t, inter"a%!lo,0ertebral
're%t "a! !&ar!l 're%t, %!ne %roble&a !nei %eritonite biliare/
Colia ne#ritia 'in litiaza reno!reterala ine%e ! '!reri lo&bare, are
ira'iaza anterior "%re or$anele $enitale e4terne "i "e in"ote"te 'e %olaSi!rie !
1e&at!rie &aro, "a! &iro"o%ia/ Antee'entele $enitale a "i ontrol!l $enital
"i eo$ra#ia orienteaza 'ia$no"ti!l/
Colia "at!rnina %oate "i&!la o %eritonita %rin ontrat!ra ab'o&inala/
-olna0!l are te&%erat!ra nor&ala, %rezinta lizere! $in$il iar 'ozarea %l!&b!l!i in
"an$e on#ir&a 'ia$no"ti!l/
Criza $a"tria etia la !n bolna0 0az!t in %lin %!"e! a!t %oate i&ita
%eritonita, 'ar antee'entele, "e&nele ne!rolo$ie, reatia -or'et,Wa""er&an
%oziti0 el!i'eaza 'ia$no"ti!l/
Por#iria a!ta inter&itenta "e &ani#e"ta %rin '!rere inten"a, ontin!a "a!
oliati, in"otita 'e ile!" 'ina&i "i !neori "tari #ebrile "i 1i%erle!oitoza/
-olna0!l %rezinta rize inter&itente, la are "e %ot a'a!$a "e&ne ne!rolo$ie,
%"i1ie "i !tanate "i &o'i#iarea !lorii !rinii, are e"te br!n,in1i"a la ontat!l
! aer!l "i ontine %or#ibilino$en 6te"t Wat"on,S1Xartz9/ Dintre a!zele rare "!nt
'e "e&nalat %!r%!ra re!&atoi'a, %eriarterita no'oa"a, aortita ab'o&inala, an$or!l
ab'o&inal, %ile#lebita/ C! tot!l e4e%tional &ai %ot #i %!"e in 'i"!tie in#art!l
++
renal, "in'roa&ele "!%rarenale 'e ti% 1e&ora$ie "a! in#art!l 'e "!%rarenale/
Fal"!l ab'o&en a!t &e'ial treb!ie 'i#erentiat 'e %eritonita a!ta 'i#!za &ai ale"
an' e4i"ta a%arare "a! ontrat!ra/
In#art!l &ioar'i a!t "e %oate in"oti 'e '!reri e%i$a"trie "i r"at!ri/
Antee'entele oronariene, arater!l '!reii, re"terea lorii tran"a&inazelor "erie
"i a latio'e1i'ro$enazei "i EC2,!l arateri"ti, on#ir&a in#art!l/
In#etiile a!te ale or$anelor toraie 6%ne!&o%atie, %le!rezie "ero,%!r!lenta9 &ai
ale" la o%ii "i a'ole"enti, %ot 'eb!ta ! '!reri ab'o&inale, 'ar #ara ontrat!ra/
Ne!ro&ial$iile torao,ab'o&inale re!&atie, 'in zona Zo"ter, 'e ori$ine 0ertebro,
&e'!lara, %ot %rezenta '!reri ab'o&inale 'i#!ze #ara ontrat!ra &!"!lara "i !
#eno&ene toraie "a! re"%iratorii/
Crizele 'e 1i%erli%i'e&ie, in 1i%erli%i'e&iile 'e ti% E "i <, %ot %rezenta
olii ab'o&inale, !neori a"oiate ! rize 'e %anreatita a!ta/
Into4iatiile $enerale %re!& 1i%erazote&ia, o&a 'iabetia "e %ot on#!n'a !
#or&ele to4ie 'e %eritonita/ Alterarea "tarii $enerale 'in !nele into4iatii $enerale
61i%erazote&ie, o&a 'iabetia, otra0iri9 a"oiata r"at!rilor "i '!rerilor ab'o&inale
%!ne %roble&e 'e 'ia$no"ti, 'ar ana&neza, "e&nele a"oiate "i li%"a ontrat!rii
le 'i#entiaza/ Mani#e"tarile ab'o&inale 'in $ri%a %ot i&ita %eritonita, &ai ale" a in
!r"!l e%i'e&iilor 'e $ri%a re"te #re0enta %eritonitelor 'e ori$ine a%en'i!lara/
Ab'o&en!l a!t 1ir!r$ial/ C1iar 'aa "e an$azea(a !n 'ia$no"ti 'i#erential !
%eritonitele, "anti!nea 1ir!r$iala 'e !r$enta "ile"te 'ia$no"ti!l intrao%erator/
In#art!l entero,&ezenteri e0ol!eaza ! "i&%to&atolo$ie #oarte '!reroa"a, !
ola%" ir!lator, balonare ab'o&inala, enterora$ie/
E0ol!tia "e #ae %e #on'!l !nei a#eti!ni %ree4i"tente3 atero&atoza, "tenoza
&itrala, #ibrilatie atriala/ Dia$no"ti!l e"te 'i#iil, "i #re0ent elioto&ia %reizeaza
'ia$no"ti!l/
Panreatita a!ta %oate 'eb!ta %rin "in'ro& %"e!'o,%eritoneal/ Teren!l
obez, a&ilazele re"!te "i e0ol!tia "!b trata&ent lari#ia 'ia$no"ti!l/ A'enita
+7
&ezenteria a!ta la o%il %oate %rezenta a%arare &!"!lara/ Are e0ol!tie
#a0orabila "!b trata&ent &e'ia&ento"/
CAPITOL VII
TRATAMENTUL PERITONITELOR
Peritonita a!t> e"te o !r$en@> 1ir!r$ial>/ Netratate **; 'in %eritonitele
a!te a! !n %ro$no"ti ne#a"t/
Trata&ent!l ?n %eritonit> a!t> treb!ie "> #ie3 %reoe, o&%le4, a'e0at Ai
"!"@in!t/
T(a$a)-$u# '8%(u(/%'a# a( 'a ",%'$%!:
S!%ri&area "!r"ei 6a!zei %eritonitei9/
Tratarea %eritonitei %rin "%>larea &in!@ioa"> a %eritone!l!i ! "er #iziolo$i Ai
'rena( e#iient al "%a@iilor 'e ?n1i"trare %o"ibile ?n %eritone!/
T(a$a)-$u# )*%'a# '"-+$ .-:
antibiotera%ie $eneral>
ree1ilibrarea 1i'roeletri>, ai'o,bazi>, n!triti0>
tratarea Ao!l!i to4io,"e%ti
&en@inerea #!n@iilor 0itale Ct &ai a%roa%e 'e %ara&etrii #iziolo$ii
M+u(%# $(apu$%' +p'%f%':
Inter0en@ie 1ir!r$ial> obli$atorie 6e4e%@ie #>Cn' %eritonitele %ri&are9/ Ea
treb!ie #>!t> 'e !r$en@> iar te1nia Ai tatia o%eratorie "> #ie ea &ai %!@in
Aoant> 'ar e#iae/
Inter0en@ia 1ir!r$ial> treb!ie "> realizeze el %!@in "!%ri&area "!r"ei 6?n1i'erea
%er#ora@iei, ?n'e%>rtarea a%en'iel!i, a tro&%ei !terine $an$renate, et/9
+<
Drena(!l a0it>@ii %eritoneale, &ai %rei" ?n zonele 'e el@ie !n'e "e 'ez0olt>
abe"ele/ E4teriorizarea 'ren!rilor "e #ae la 'i"tan@> 'e %la$a o%eratorie !n'e
'eli0itatea a"i$!r> ea &ai b!n> e0a!are/
Da> inter0en@ia 1ir!r$ial> Ai 'rena(!l "!nt #atori e"en@iali "%ei#ii ai
trata&ent!l!i %eritonitei, "!e"!l #inal Ai %ro$no"ti!l 'e%i' 'e "trite@ea ! are
"!nt a%liate %ro%!nerile $enerale/
M+u(% $(apu$%' /-(a#:
Rea%o" la %at %ozi@ie "e&iaAezCn'>/
A"%ira@ie nazo,$a"tri>, "e in"tit!ie 'in %ri&ele &o&ente 'e la "!"%ii!nea
!nei %eritonite/ Prin aea"t> &>"!r> "e e0it> 0>r">t!ra Ai %o"ibilitatea a"%ira@iei
tra1eo,bronAie/
Ree1ilibrarea 1i'roeletroliti> e"te o&%onenta tera%e!ti> &a(or>/
Cantit>@ile 'e a%> Ai eletroli@i e treb!ie" a'&ini"trate "e "tabile" ?n #!n@ie 'e
ten"i!nea arterial>, %re"i!nea 0enoa"> entral>, iono$ra&>, 1e&atorit, "e&ne
linie obieti0e/
Ele "e a'&ini"treaz> %e ale intra0enoa"> %rin ateterizarea !nei 0ene &ari/
Se a'&ini"treaz>3
, "er #iziolo$i 2::),+::: &l, ! !n a%ort 'e EB,2) $ NaCl L
, $l!oz> <,E:; 6! in"!lin> <U la 2<: &l9 a0Cn' !n a%ort alori 2::),+:::
&l L
, NaCl, 8Cl ?n "ol!@ii &olare, ?n #!n@ie 'e iono$ra&a "eri> L
, Ree1ilibrarea ir!latorie 60ole&i>9 "e #ae %e lCn$> "ol!@iile 1i'roeletrie,
! %la"&> "a! "Cn$e/ Dn az 'e !r$en@> 0ital> "e ?ntreb!in@eaz> 0a"o%re"oare
6a'renalin>, noa'renalin> E,7 &$ ?n "ol!@ii &aro&ole!lare De4tran ):,
R1eo&ate4 E:::,E<:: &l9 L
, FFC 61e&i"!inat 'e 1i'roortizon9 <::,2::) &$, ?n %er#!zie, a&elioreaz>
rez!ltatele ree1ilibr>rii ir!latoriiL
, A&eliorarea on'i@iilor re"%iratorii "e ob@ine %rin o4i$eno,tera%ieL
+=
, Trata&ent!l antibioti e"te etio%atolo$i, 0a !%rin'e antibiotie ! "%etr!
lar$, %e Ct %o"ibil e4ate %e antibio$ra&a "ere@iei %!r!lente %eritoneale/ Se
a'&ini"treaz> ?n %er#!zii, i/&/ Ai e0ent!al ?n %eritone!3 Peniilin> E:,E< &lG27
ore %o"to%erator, a"oiate ! alte antibiotie 8ana&iina, Clora&#eniol/
Pre0enirea Ai tratarea oli$oan!riei on"t> ?n ree1ilibrarea ir!latorie Ai
1i'roioni>, '!%> !n oareare $ra' 'e re1i'ratare %rin 'i!rez> o"&oti> 6$l!oz>
2:;9/
Coretarea ai'ozei &etabolie ! "ol!@ii &olare 'e NaFC.
+
E:::,2::)
&lG27 ore/ E"te %re#erat %entr! a@i!nea "a intrael!lar> "ol!@ia TFAM/
PARTEA SPECIALA
ROLUL ASISTENTEI MEDICALE GN GNGRIHIREA
BOLNAVILOR CU PERITONIT ACUT
G-/(%>%(a p("p(a$"(% a ,"#-a!%#"(
Dn$ri(irea bolna0ilor ?nainte 'e inter0en@ia 1ir!r$ial>, ?n "o%!l %re$>tirii
lor, 0ariaz> ?n ra%ort ! &oti0!l %entr! are "e #ae inter0en@ia, ! "tarea $eneral> a
bolna0!l!i, %re!& Ai ! ti&%!l a0!t la 'i"%ozi@ie %Cn> ?n &o&ent!l o%era@iei/
G-/(%>%(a ,"#-a!u#u% .- p(%"a*a p"+$"p(a$"(%
Dn %erioa'a %o"tnaroti>, %Cn> la re0enirea o&%let> a !noAtin@ei
bolna0!l!i, ae"ta 0a #i "!%ra0e$1eat/ El n! %oate #i l>"at "in$!r >i '!%> naroz>
%ot "> a%ar> o&%lia@ii, !& ar #i3 >'ere ?na%oi a li&bii, t!lb!r>ri 'e re"%ira@ie, 'e
ir!la@ie, a"#i4ie, et/
CCteo'at> bolna0!l %rezint> n!&ai $re@!ri Ai #ae e#ort!ri %entr! a 0o&a,
alteori eli&in> on@in!t!l "to&aal3 "! $a"tri, bil>, e0ent!al &!ozit>@i
#arin$iene/ F!n@iile "oar@ei erebrale ne#iin' ?n> re"tabilite, bolna0!l "e %oate
"!la, %oate intra ?n a$ita@ie, ?near> ">,Ai 'e"#a> %an"a&ent!l, et/
+)
GNGRIHIREA BOLNAVILOR CU PERITONIT ACUT
&'( &)*+*& +%. 1
&,)-.-%-' "'/-)0%
R/M/ ?n 0Cr"t> 'e +< ani, "e4 &a"!lin, 'o&iiliat ?n o&!na
Mi1>ileni, (!'e@!l -otoAani e"te a'!" la "er0ii!l 'e !r$en@> ! "al0area, a!zCn'
#a%t!l > ?n &o' br!" a a%>r!t o '!rere 0iolent> "!b #or&> 'e ar"!r> ! loalizare
?n e%i$a"tr! Ai 'e"eori ira'ieri ?n "%ate/
-olna0!l e"te !no"!t a on"!&ator 'e b>!t!ri aloolie Ai a #o"t internat
?n re%etate rCn'!ri ?n "%ital, ! 'ia$no"ti!l 'e !ler $a"tro'!o'enal/
-olna0!l, %e lCn$> '!rere, &ai %rezint> $re@!ri, 0>r">t!ri, el ia o %ozi@ie
antolo$i>, ! &Cinile ?n re$i!nea e%i$a"tri>/ El %erzint> !n #aie" an4io", o1i
?ner>na@i, %aloare, tran"%ira@ie, e4tre&it>@i rei/
La in"%e@ie "e on"tat> i&obilizarea %eretel!i ab'o&inal ?n ti&%!l
re"%ira@iei/
La %al%are 1i%ere"tezia !tanat>, la atin$erea re$i!nii e%i$a"trie "e&n!l
-l!&ber$ %rezent/
La a"!lta@ie liniAte ab"ol!t> a ab'o&en!l!i/
T!Ae!l retal %ro0oa> '!rere 0ie la a%>"area #!n'!l!i 'e "a Do!$la"/
-olna0!l "e interneaz> %entr! in0e"ti$a@ii Ai trata&ent/
Antee'ente3
+B
1ere'oolaterale ne"e&ni#iati0e
%er"onale bolna0!l a &ai #o"t internat a!& 7 l!ni ! $a"trit>/
+*
PLAN DE GNGRIHIRE PREOPERATOR
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%! I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
),:+,2::) E/ Re"%ira@ie "!%er#iial> a!zat> 'e
'!rere &ani#e"tat> %rin 'i"%nee
, Dnl>t!rarea 'i"%neei,
, A"i$!rarea !nei re"%ira@ii
nor&ale ?n ti&%
, Paient!l "> %rezinte !n
rit& re"%irator re$!lat ?n
ti&% 'e 27 ore
, A"i$!rarea re%ao"!l!i ab"ol!t la %at ?n %ozi@ie
"e&iaAezCn'> "a! ',' ! a%!l ?ntr,o %arte/
, A%liarea !nei %!n$i 'e $1ea@> %e ab'o&en
, Aeri"irea a&erei Ai te&%erat!r> a'e0at>
, .4i$enotera%ie
, N! "e a'&ini"treaz> &or#in>/
Paient!l %rezint> o
!Aoar> a&eliorare
2/ Cir!la@ie &o'i#iat>, a!zat> 'e
'!rere, &ani#e"tat> %rin %!l" ra%i' Ai
"lab, ten"i!ne arterial> ">z!t>, "tare
'e an4ietate, neliniAte
, Paient!l "> %rezinte o
ir!la@ie a'e0at>
, P!l"!l, TA "> aib> 0alori
nor&ale ?n ti&% 'e 27 'e
ore
, S> #ie e1ilibrat %"i1i
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
%!l"!l, TA, re"%ira@ia
, Pozi@ionare, a"i$!rarea re%ao"!l!i ab"o!lt
, 21ea@> %e ab'o&en, e#et!area %"i1otera%iei
Paient!l %rezint> o
!Aoar> a&eliorare Ai
e"te e1ilibrat %"i1i
+/ .%rirea tranzit!l!i inte"tinal,
&o'i#iarea inte$rit>@ii t!b!l!i
'i$e"ti0, &ani#e"tat> %rin on"ti%a@ie/
, %aient!l "> %rezinte !n
tranzit inte"tinal ?n li&itele
#iziolo$ie ti&% 'e 2 zile/
, Paient!l "> %rezinte !n
"a!n nor&al alitati0 Ai
antitati0/
, I "e 0a a%lia o "on'> 'e a"%ira@ie nazo,$a"tri>,
"on'> 'e $aze
, Paient!l e"te in0itat "> ?Ai $olea"> 0ezia
!rinar>
, Pre$>tirea Ct &ai !r$ent> a %aient!l!i %entr!
o%era@ie/
Tranzit!l inte"tinal
e"te o%rit/
7:
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
7/ De"1i'ratare a!zat> 'e %roe"!l
in#e@io", &ani#e"tat> %rin $re@!ri,
0>r">t!ri, #ebr>/
, Paient!l "> #ie e1ilibrat
1i'roeletri
, Paient!l "> aib> o "tare
'e bine, 'e on#ort #izi
#>r> $re@!ri, 0>r">t!ri ?n
ti&% 'e 271
, Se 0a ?ntrer!%e ali&enta@i Ai &e'ia@ia oral>/
, I "e 0a #ae ree1ilibrarea 1i'roeletri> Ai
0ole&i>/
, Pozi@ionare oret>/
, Dl a(!t> ?n ti&%!l 0>r">t!rilor Ai %>"treaz>
%ro'!"!l eli&inat, ?i o#er> !n %a1ar ! a%> "> ?Ai
l>tea"> $!ra/
, .b"er0area Ai notarea antit>@ii 0>r">t!rilor ?n
#oaia 'e ob"er0a@ie/
, A(!t> ?n &en@inerea !rat> a te$!&entelor
%aient!l!i Ai "1i&barea len(eriei ori 'e Cte ori
e"te ne0oie/
Paient!l e"te
ree1ilibrat
1i'roeletri Ai
0ole&i/
</ Ina%aitate 'e a "e ?n$ri(i "in$!r,
a!zat> 'e '!reri &ari, &ani#e"tat>
%rin a"tenie, obo"eal>/
, Se 0a %re$>ti %aient!l 'in
%!nt 'e 0e'ere #izi Ai
%"i1i/
, I "e 0a e4%lia nee"itatea
at!l!i o%erator
, Pre$>tirea %aient!l!i
%entr! o%era@ie/
, Pre$>tirea C&%!l!i
o%erator ?n ti&% 'e 271/
, Paient!l e"te a(!tat "> #a> o baie ! a%> Ai
">%!n/
, Va #i a(!tat "> ?&brae len(eria 'e "%ital
, Re$i!nea !n'e !r&eaz> "> "e e#et!eze
inter0en@ia 1ir!r$ial> e"te "%>lat>, ra">,
'e$re"at>, 'ezin#etat> Ai a%oi ao%erit> ! !n
C&% "teril/
, Te$!&entele "!nt
!rate
, Paient!l!i i ",a
realizat o b!n>
%re$>tire
%reo%eratorie #izi> Ai
%"i1i>
7E
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
=/ Fria 'e o%era@ie, a!zat> 'e
'!reri, &ani#e"tat> %rin "tre", "tare
'e neliniAte, a$ita@ie/
, Pre$>tirea %reo%eratorie
, A'&ini"trarea &e'ia@iei
%reana"tezie
, Tran"%ort!l la "ala 'e
o%era@ie/
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
#!n@iile 0itale, TA, %!l", re"%ira@ie Ai 'i!rez>/
, Se e#et!eaz> te"tarea la ana"tezie 64ilin>9,
te"tarea la io' %entr! a 'e%i"ta e0ent!alele rea@ii
aler$ie/
, C! +: &in ?nainte 'e inter0en@ie "e a'&ini"treaz>
la in'ia@ia &e'i!l!i Cte o #iol> 'e &ia$lin Ai
atro%in> i/0/
, C! a(!tor!l !n!i >r!ior %aient!l e"te
tran"%ortat la "ala 'e o%era@ie/
, %aient!l e"te al&
a !r&are a in"tal>rii
e#et!l!i
&e'ia&ent!l!i/
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%! I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("# E!a#ua(
72
PLAN DE GNGRIHIRE POSTOPERATOR
*#/a$
B,:+,2::)
*,:+,2::)
E/ Mo'i#iarea a&%lit!'inii re"%ira@iei
a!zat> 'e ane"tezie &ani#e"tat> %rin
'i"%nee/
, S!%ra0e$1erea rit&!l!i
re"%irator/
, Co&baterea 'i"%neei ?n =,
E2 ore/
, A"i$!rarea !nei a&ere aeri"ite Ai o te&%erat!r>
a'e0at>/
, .4i$enotera%ie
, Fre0en@a
re"%iratorie E)
re"%G&in/
, P!l" %!@in
aelerat/
2/ Ina%aitatea 'e a "e &iAa 'atorit>
e#et!>rii ane"tezi!l!i Ai o%era@iei
&ani#"tat> %rin a&e@eli, "o&nolen@>/
, Tran"%ortarea bolna0!l!i
! tar$a 'e la "ala 'e
o%era@ie ?n "alon Ai
in"talarea l!i ?n %at/
, Paient!l e"te a'!" 'e la "ala 'e o%era@ie ?n "alon
%rote(at 'e !n earAa#, Ai e"te in"talat ?n %at ?n
%ozi@ie ',' #>r> %ern> "!b a% Ai e"te "!%ra0e$1eat
ontin!!, !r&>rin'!,i,"e #!n@iile 0itale, %!l", TA,
re"%ira@ie, 'i!reza/
, S!%ra0e$1erea t!b!rilor 'e 'ren Ai "1i&barea
%!n$ilor ori 'e Cte ori e"te ne0oie/
, D!%> = ore 'e ra1ioane"tezie bolna0!l e"te a(!tat
"> "e ri'ie ?n %ozi@ie "e&iaAezCn'>/
, Paient!l a!z> o
"l>bire a
or$ani"&!l!i Ai
"enza@ia 'e
a&e@eal> la
ri'iare/
+/ D!rere a!t> a!zat> 'e inter0en@ia
1ir!r$ial> &ani#e"tat> %rin neliniAte,
a$ita@ie/
, Paient!l "> %rezinte o
"tare 'e b!n> 'i"%ozi@ie #>r>
'!reri/
, S>,Ai rea%ete ?nre'erea
?n #or@ele %ro%rii ti&% 'e +,
7 zile/
, S> bene#iieze 'e !n
So&n o'i1nitor ?n ti&% 'e
27 ore/
, Cal&area '!rerii
, E#et!area %"i1o tera%iei/
, Cal&area '!rerii %rin a'&ini"trare 'e al&ante
, A"i$!rarea !n!i li&at o'i1nitor, %at o&o',
a&er> aeri"it>, te&%erat!r> a'e0at>/
S1i&barea %ozi@iei ori 'e Cte ori e"te ne0oie,
%entr! a e0ita a%ari@ia e"arelor/
UAoar> a&eliorare
a '!rerilor/
7+
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
E+,:+,2::)
E<,:+,2::)
7/ Di#i!ltate 'e a "e ali&enta Ai
1i'rata 'atorit> inter0en@iei
1ir!r$iale &ani#e"tat> 'e '!rere/
, Paient!l treb!ie "> #ie
e1ilibrat 1i'roeletroliti
Ai 0ole&i/
, S> %rezinte o "tare 'e
bine, #>r> $re@!ri Ai
0>r">t!ri, ?n 27 ore/
, Ali&entarea %aient!l!i %e ale %arenteral> ?n
%ri&ele + zile '!%> o%era@ie/
, Pre$>tirea Ai "er0irea %aient!l!i ! ali&enta@ie
li1i'> '!%> ea 'e,a treia zi, eai ne?n'!lit, "!%e
"tre!rate, a%oi, ?n !r&>toarele zile, %i!re 'e
arto#i, brCnz> 'e 0ai, o!> &oi, o&%ot!ri/
, Me"ele 0or #i ?n onentra@ii &ii Ai 'e"e 6<,)
&e"e %e zi9/
, Va #i interzi" on"!&!l b>!t!rilor aloolie,
#!&at!l/
, Vor #i e4l!"e ali&entele are %ro'! balon>ri,
$re! 'i$erabile/
,Vita&inotera%ie la in'ia@ia &e'i!l!i/
, Paient!l e"te
e1ilibrat
n!tri@ional, n!
%rezint> "e&ne 'e
'e"1i'ratare/
E=,:+,2::)
E*,:+,2::)
</ Di#i!ltate 'e a "e &iAa, a!zat>
'e '!rere, &ani#e"tat> %rin a&e@eli,
%ier'erea e1ilibr!l!i
, Paient!l "> aib> o %o"t!r>
a'e0at>
, S> aib> ton!"!l &!"!lar
Ai #or@a &!"!lar> %>"trat>
, S> %rezinte &obilitate
nor&al>/
, Paient!l "> n! %rezinte
o&%lia@ii a e"are 'e
'e!bit, et/
, A(!t> %aient!l ?n #!n@ie 'e "tarea $eneral>/
, E#et!area toaletei %e re$i!ni re"%etCn'!,i
%!'oarea/
S!%ra0e$1erea zilni> a %l>$ii Ai t!b!rilor 'e 'ren/
, S1i&barea %an"a&ent!l!i ?n az!l Cn' ae"ta "e
&!r'>reAte ! "ere@ii, "Cn$e, et/
, A(!t> %aient!l ">,Ai "1i&be len(eria 'e or%/
, Paient!l
%rezint> te$!&ente
Ai &!oa"e inte$re/
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%! I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("# E!a#ua(
77
*#/a$
)/ Di#i!ltate 'e a eli&ina, a!zat> 'e
'e"1i'ratare, &ani#e"tat> %rin
oli$oan!rie 'ia#orez>/
,Ree1ilibrare
1i'roeletroliti> Ai
0ole&i> a or$ani"&!l!i ?n
<,) zile
, S>,Ai rea%ete ontrol!l
"#interelor/
, S> #ie e1ilibrat %"i1i/
, S> aib> o "tare 'e bine
#izi Ai %"i1i/
, Paient!l e"te in0itat "> !rineze "%ontan/
, Se 0a "er0i %aient!l ! bazinet, %lo">/
, A'&ini"trarea 'e eai!ri, o&%ot!ri, "!!ri/
, La in'ia@ia &e'i!l!i "e a'&ini"treaz> &e'ia@ie
'i!reti>/
, A"i$!rarea i$ienei loale ri$!roa"> '!%> #ieare
eli&inare/
, In"talarea "on'ei 0eziale la in'ia@ia &e'i!l!i/
, Son'a(!l 0ezial
",a #>!t #>r>
%roble&e/
B/ An4ietate a!zat> 'e ne!noaAterea
%ro$no"ti!l!i bolii, &ani#e"tat> %rin
?n$ri(orare, tea&>/
, Paient!l "> bene#iieze
'e !n &e'i! 'e "i$!ran@>,
#>r> ai'ente Ai in#e@ii/
, S> #ie e1ilibrat %"i1i/
, A&%la"eaz> %aient!l ?n "alon ?n #!n@ie 'e "tarea
"a 'e a#e@i!ne/
, In#or&eaz> Ai "tabileAte ?&%re!n> ! %aient!l
%lan!l 'e re!%erare a "t>rii 'e ">n>tate Ai reAtere a
rezi"ten@ei or$ani"&!l!i/
, E'!> %aient!l %entr! %ro#ila4ia "e!n'ar> a
bolii3 e0itarea "tre"!l!i, a ali&enta@iei iritante
%entr! "to&a, ren!n@area la obiei!ri '>!n>toare/
7<
7=
&'( &)*+*& +%. 2
&,)-.-%-' "'/-)0%
T/I/ ?n 0Cr"t> 'e 7: ani, "e4 #e&inin, 'o&iiliat> ?n loalitatea -!!re"ti a
#o"t internat> %e 'ata 'e 27,:7,2::), ?n !r&a lo0it!rilor %ri&ite ?n zona
ab'o&inal>/ D!%> ae"te lo0it!ri ea a!z> '!reri 0iolente ?n re$i!nea
ab'o&inal>, 1i%o$a"tr!, ne%!tCn' #ae nii !n e#ort/
A 'o!a zi e"te tran"%ortat> 'e !r$en@> la S%ital!l T!'e@ean -otoAani/
-olna0a, %e lCn$> '!rere, &ai %rezint> $re@!ri, 0>r">t!ri, an4ietate, "tare
$eneral> alterat>/
La in"%e@ie "e on"tat> i&obilizarea %eretel!i ab'o&inal ?n ti&%!l
re"%ira@iei/
La %al%are 1i%ere"tezia !tanat>, la atin$erea re$i!nii e%i$a"trie "e&n!l
-l!&ber$ %rezent/
La a"!lta@ie liniAte ab"ol!t> a ab'o&en!l!i/
T!Ae!l retal Ai 0a$inal %ro0oa> '!rere 0ie la a%>"area #!n'!l!i 'e "a
Do!$la"/
Aii e"te internat> %e "e@ia 1ir!r$ie ?n !r&a in0e"ti$a@iilor #>!te I "e
"tabileAte 'ia$no"ti!l 'e %eritonit> a!zat> 'e %er#ora@ia inte"tin!l!i Ai e"te
"!%!"> inter0en@iei 1ir!r$iale/
Antee'ente3
1ere'oolaterale ne"e&ni#iati0e
%er"onale ?n o%il>rie a #>!t r!(eol> iar la 0Cr"ta 'e 2B 'e ani a o"t o%erat> 'e
a%en'iit>/
NaAteri 2
A0ort!ri :
7)
PLAN DE GNGRIHIRE PREOPERATOR
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
2<,:7,2::) E/ Re"%ira@ie "!%er#iial> a!zat> 'e
'!rere &ani#e"tat> %rin 'i"%nee
, Dnl>t!rarea 'i"%neei,
, A"i$!rarea !nei re"%ira@ii
nor&ale ?n ti&%
, Paient!l "> %rezinte !n
rit& re"%irator re$!lat ?n
ti&% 'e 27 ore
, A"i$!rarea re%ao"!l!i ab"ol!t la %at ?n %ozi@ie
"e&iaAezCn'> "a! ',' ! a%!l ?ntr,o %arte/
, A%liarea !nei %!n$i 'e $1ea@> %e ab'o&en
, Aeri"irea a&erei Ai te&%erat!r> a'e0at>
, .4i$enotera%ie
, N! "e a'&ini"treaz> &or#in>/
Paient!l %rezint> o
!Aoar> a&eliorare
2/ Cir!la@ie &o'i#iat>, a!zat> 'e
'!rere, &ani#e"tat> %rin %!l" ra%i' Ai
"lab, ten"i!ne arterial> ">z!t>, "tare
'e an4ietate, neliniAte
, Paient!l "> %rezinte o
ir!la@ie a'e0at>
, P!l"!l, TA "> aib> 0alori
nor&ale ?n ti&% 'e 27 'e
ore
, S> #ie e1ilibrat %"i1i
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
%!l"!l, TA, re"%ira@ia
, Pozi@ionare, a"i$!rarea re%ao"!l!i ab"o!lt
, 21ea@> %e ab'o&en, e#et!area %"i1otera%iei
Paient!l %rezint> o
!Aoar> a&eliorare Ai
e"te e1ilibrat %"i1i
+/ .%rirea tranzit!l!i inte"tinal,
&o'i#iarea inte$rit>@ii t!b!l!i
'i$e"ti0, &ani#e"tat> %rin on"ti%a@ie/
, %aient!l "> %rezinte !n
tranzit inte"tinal ?n li&itele
#iziolo$ie ti&% 'e 2 zile/
, Paient!l "> %rezinte !n
"a!n nor&al alitati0 Ai
antitati0/
, I "e 0a a%lia o "on'> 'e a"%ira@ie nazo,$a"tri>,
"on'> 'e $aze
, Paient!l e"te in0itat "> ?Ai $olea"> 0ezia
!rinar>
, Pre$>tirea Ct &ai !r$ent> a %aient!l!i %entr!
o%era@ie/
Tranzit!l inte"tinal
e"te o%rit/
7B
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
7/ De"1i'ratare a!zat> 'e %roe"!l
in#e@io", &ani#e"tat> %rin $re@!ri,
0>r">t!ri, #ebr>/
, Paient!l "> #ie e1ilibrat
1i'roeletri
, Paient!l "> aib> o "tare
'e bine, 'e on#ort #izi
#>r> $re@!ri, 0>r">t!ri ?n
ti&% 'e 271
, Se 0a ?ntrer!%e ali&enta@i Ai &e'ia@ia oral>/
, I "e 0a #ae ree1ilibrarea 1i'roeletri> Ai
0ole&i>/
, Pozi@ionare oret>/
, Dl a(!t> ?n ti&%!l 0>r">t!rilor Ai %>"treaz>
%ro'!"!l eli&inat, ?i o#er> !n %a1ar ! a%> "> ?Ai
l>tea"> $!ra/
, .b"er0area Ai notarea antit>@ii 0>r">t!rilor ?n
#oaia 'e ob"er0a@ie/
, A(!t> ?n &en@inerea !rat> a te$!&entelor
%aient!l!i Ai "1i&barea len(eriei ori 'e Cte ori
e"te ne0oie/
Paient!l e"te
ree1ilibrat
1i'roeletri Ai
0ole&i/
</ Ina%aitate 'e a "e ?n$ri(i "in$!r,
a!zat> 'e '!reri &ari, &ani#e"tat>
%rin a"tenie, obo"eal>/
, Se 0a %re$>ti %aient!l 'in
%!nt 'e 0e'ere #izi Ai
%"i1i/
, I "e 0a e4%lia nee"itatea
at!l!i o%erator
, Pre$>tirea %aient!l!i
%entr! o%era@ie/
, Pre$>tirea C&%!l!i
o%erator ?n ti&% 'e 271/
, Paient!l e"te a(!tat "> #a> o baie ! a%> Ai
">%!n/
, Va #i a(!tat "> ?&brae len(eria 'e "%ital
, Re$i!nea !n'e !r&eaz> "> "e e#et!eze
inter0en@ia 1ir!r$ial> e"te "%>lat>, ra">,
'e$re"at>, 'ezin#etat> Ai a%oi ao%erit> ! !n
C&% "teril/
, Te$!&entele "!nt
!rate
, Paient!l!i i ",a
realizat o b!n>
%re$>tire
%reo%eratorie #izi>
Ai %"i1i>
7*
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
=/ Fria 'e o%era@ie, a!zat> 'e
'!reri, &ani#e"tat> %rin "tre", "tare
'e neliniAte, a$ita@ie/
, Pre$>tirea %reo%eratorie
, A'&ini"trarea &e'ia@iei
%reana"tezie
, Tran"%ort!l la "ala 'e
o%era@ie/
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
#!n@iile 0itale, TA, %!l", re"%ira@ie Ai 'i!rez>/
, Se e#et!eaz> te"tarea la ana"tezie 64ilin>9,
te"tarea la io' %entr! a 'e%i"ta e0ent!alele rea@ii
aler$ie/
, C! +: &in ?nainte 'e inter0en@ie "e a'&ini"treaz>
la in'ia@ia &e'i!l!i Cte o #iol> 'e &ia$lin Ai
atro%in> i/0/
, C! a(!tor!l !n!i >r!ior %aient!l e"te
tran"%ortat la "ala 'e o%era@ie/
, %aient!l e"te al&
a !r&are a in"tal>rii
e#et!l!i
&e'ia&ent!l!i/
<:
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
2<,:7,2::) E/ Ina%aitatea 'e a "e &iAa 'atorit>
e#et!>rii ane"tezi!l!i Ai o%era@iei
&ani#"tat> %rin a&e@eli, "o&nolen@>/
, Tran"%ortarea bolna0!l!i
! tar$a 'e la "ala 'e
o%era@ie ?n "alon Ai
in"talarea l!i ?n %at/
, Paient!l e"te a'!" 'e la "ala 'e o%era@ie ?n "alon
%rote(at 'e !n earAa#, Ai e"te in"talat ?n %at ?n
%ozi@ie ',' #>r> %ern> "!b a% Ai e"te "!%ra0e$1eat
ontin!!, !r&>rin'!,i,"e #!n@iile 0itale, %!l", TA,
re"%ira@ie, 'i!reza/
, S!%ra0e$1erea t!b!rilor 'e 'ren Ai "1i&barea
%!n$ilor ori 'e Cte ori e"te ne0oie/
, D!%> 27 ore 'e ra1ioane"tezie bolna0!l e"te a(!tat
"> "e ri'ie ?n %ozi@ie "e&iaAezCn'>/
, Paient!l a!z> o
"l>bire a or$ani"&!l!i
Ai "enza@ia 'e a&e@eal>
la ri'iare/
2+,:<,2::) 2/ D!rere a!t> a!zat> 'e inter0en@ia
1ir!r$ial> &ani#e"tat> %rin neliniAte,
a$ita@ie/
+/ Di#i!ltate 'e a "e ali&enta Ai
1i'rata 'atorit> inter0en@iei
1ir!r$iale &ani#e"tat> 'e '!rere/
, Paient!l "> %rezinte o
"tare 'e b!n> 'i"%ozi@ie #>r>
'!reri ?n 27,7B ore
, S>,Ai rea%ete ?nre'erea
?n #or@ele %ro%rii ti&% 'e 2,
= zile/
, Cal&area '!rerii
, E#et!area %"i1o tera%iei/
, Cal&area '!rerii %rin a'&ini"trare 'e al&ante
, A"i$!rarea !n!i li&at o'i1nitor, %at o&o',
a&er> aeri"it>, te&%erat!r> a'e0at>/
S1i&barea %ozi@iei ori 'e Cte ori e"te ne0oie,
%entr! a e0ita a%ari@ia e"arelor/
UAoar> a&eliorare a
'!rerilor/
+/ Di#i!ltate 'e a "e ali&enta Ai
1i'rata 'atorit> inter0en@iei
1ir!r$iale &ani#e"tat> 'e '!rere/
, Paient!l treb!ie "> #ie
e1ilibrat 1i'roeletroliti
Ai 0ole&i ?n 2,) zile
, S> %rezinte o "tare 'e
bine, #>r> $re@!ri Ai
0>r">t!ri, ?n =,E2 zile/
, Ali&entarea %aient!l!i %e ale %arenteral> ?n
%ri&ele + zile '!%> o%era@ie/
, Pre$>tirea Ai "er0irea %aient!l!i ! ali&enta@ie
li1i'> '!%> ea 'e,a treia zi, eai ne?n'!lit, "!%e
"tre!rate, a%oi, ?n !r&>toarele zile, %i!re 'e
arto#i, brCnz> 'e 0ai, o!> &oi, o&%ot!ri/
, Me"ele 0or #i ?n onentra@ii &ii Ai 'e"e 6<,)
&e"e %e zi9/
, Va #i interzi" on"!&!l b>!t!rilor aloolie,
#!&at!l/
, Paient!l e"te
e1ilibrat n!tri@ional,
n! %rezint> "e&ne 'e
'e"1i'ratare/
<E
PLAN DE GNGRIHIRE POSTOPERATOR
, Vor #i e4l!"e ali&entele are %ro'! balon>ri,
$re! 'i$erabile/
,Vita&inotera%ie la in'ia@ia &e'i!l!i/
7/ Di#i!ltate 'e a "e &iAa, a!zat>
'e '!rere, &ani#e"tat> %rin a&e@eli,
%ier'erea a1ilibr!l!i
, Paient!l "> aib> o %o"t!r>
a'e0at>
, S> aib> ton!"!l &!"!lar
Ai #or@a &!"!lar> %>"trat>
, S> %rezinte &obilitate
nor&al>
, Paient!l "> n! %rezinte
e"are 'e 'e!bit
, A(!t> %aient!l "> ?Ai "1i&be %ozi@ia ori 'e Cte
ori e"te ne0oie/
, A(!t> %aient!l "> "e ri'ie 'in %at Ai "> "e 'ea (o"
Ai "> #a> &ii %li&b>ri
, E#et!eaz> &a"a(e zilnie la re$i!nile %re'i"%!"e
e"arelor, la ni0el!l &e&brelor in#erioare, #olo"irea
olailor 'e a!i!/
, A"i$!rarea len(eriei, te$!&entelor, a len(eriei 'e
%at Ai or%/
, E#et!area e4eri@iilor %a"i0e Ai ati0e/
, Paient!l %rezint> o
"tare 'e bine #izi Ai
%"i1i
, E4e!t> &iA>ri
ati0e Ai %a"i0e/
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
</ Ina%aitate 'e a "e ?n$ri(i "in$!r,
'atorit> inter0en@iei 1ir!r$iale,
&ani#e"tat> %rin %ozi@ie nea'e0at>,
'!rere/
, Paient!l "> %rezinte
te$!&entele Ai &!oa"ele
!rate/
, S>,Ai re'obCn'ea"> "ti&a
'e "ine ?n ),E7 zile/
, S> %rezinte o "tare 'e
on#ort/
=/ Mo'i#i>rile a&%lit!'inii
re"%ira@iei, a!zat> 'e ane"tezie
, S!%ra0e$1erea rit&!l!i
re"%irator/
, A"i$!rarea !nei a&ere aeri"ite Ai o te&%erat!r>
a'e0at>/
Fre0en@a re"%iratorie
5 E) re"%/G&in/
<2
&ani#e"tat> %rin 'i"%nee/ , Co&baterea 'i"%neei ?n 7,
E2 ore/
, M>"!rarea Ai notarea #!n@iilor 0itale, %!l",
re"%ira@ie, TA/
, .4i$enotera%ie/
P!l" %!@in aelerat
TA 5 E2:,): && F$
)/ Di#i!ltate 'e a eli&ina, a!zat> 'e
'e"1i'ratare, &ani#e"tat> %rin $re@!ri,
0>r">t!ri/
, Ree1ilibrare
1i'roeletroliti> Ai
0ole&i> a or$ani"&!l!i ?n
2,7B ore/
, S>,Ai rea%ete ontrol!l
"#interelor ?n 2,+ zile/
, S> aib> o "tare 'e bine,
#>r> 0>r">t!ri, $re@!ri ?n 2,=
ore/
, Paient!l e"te in0itat "> !rineze "%ontan/
, Se 0a "er0i %aient!l ! bazinet/
, A'&ini"trarea 'e eai!ri 'i!retie, la4ati0e/
, La in'ia@ia &e'i!l!i "e a'&ini"treaz> &e'ia@ie
'i!reti> Ai "e 0a #ae li"&>/
, A"i$!rarea i$ienei ri$!roa"e '!%> #ieare
eli&inare/
, In"talarea "on'ei 0eziale la in'ia@ia &e'i!l!i/
Paient!l n! &ai
%rezint> $re@!ri,
0>r">t!ri Ai eli&inarea
"a!n!l!i Ai a !rinei
e"te ?n li&ite
#iziolo$ie/
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
B/ An4ietate a!zat> 'e ne!noaAterea
%ro$no"ti!l!i bolii, &ani#e"tat> %rin
?n$ri(orare, tea&>/
, Eli&inarea an4iet>@ii Ai
atra$erea aten@iei a"!%ra
nor&eor 'e 0ia@> %e are
treb!ie "> le re"%ete ?n E,2
">%t>&Cni/
, F!rnizeaz> %aient!l!i !noAtin@ele nee"are
'e"%re o%era@ie, 'e"%re o&%lia@iile are %ot
a%are, 'e"%re trata&ent!l 'e ?ntre@inere Ai 'e"%re
ali&enta@ia %e are treb!ie "> o re"%ete/
Paient!l e"te
e1ilibrat %"i1i/
*/ Ri" 'e alterare a "t>rii $enerale/
Ca!za3 %er#ora@ia olon!l!i
&ani#e"tat> %rin 'e"1i'ratare/
, Paient!l "> %rezinte
%erioa'e 'e aal&ie Ct &ai
l!n$i/
, S> n! %rezinte &ani#e"t>ri
arateri"tie
o&%lia@iilor/
, S!%ra0e$1erea %!l"!l!i, TA, 'i!rezei
, Reoltarea %ro'!"elor ?n 0e'erea e4a&en!l!i 'e
laborator 6"Cn$e, &aterii #eale9/
, S!%ra0e$1erea &ani#e"t>rilor 'e 'e"1i'ratare/
Paient!l n! %rezint>
o&%lia@ii "a! "e&ne
'e 'e"1i'ratare/
E: Di#i!ltate 'e a "e o'i1ni a!zat>
'e '!rere, &ani#e"tat> %rin in"o&nie/
, Paient!l "> %rezinte !n
"o&n o'i1nitor/
, S> n! %rezinte '!reri/
, A"i$!rarea !n!i li&at ore"%!nz>tor, a&ere
aeri"ite, %at on#ortabil, te&%erat!r> a'e0at>/
, A'&ini"trarea trata&ent!l!i &e'ia&ento"
%re"ri" 'e &e'i 6"e'ati0 #enobarbital,
'iaze%a&9/
D!rerile ",a!
a&eliorat iar %aienta
%rezint> !n "o&n
o'i1nitor/
<+
&'( &)*+*& +%. 3
&,)-.-%-' "'/-)0%
Paienta M/S/ ?n 0Cr"t> 'e 27 ani, 'o&iiliat> ?n loalitatea -!!re"ti e"te
a'!"> la "er0ii!l 'e !r$en@> %e 'ata 'e * &ai 2::), a!zCn' '!reri 0iolente ?n #o"a
ilia> 'rea%t> are a! a%>r!t ?n %lin> ">n>tate Ai are ira'iaz> ?n re$i!nea
e%i$a"tri>/ C! 'o!> l!ni ?n !r&> ea a &ai %rezentat '!reri 'ar are a! #o"t
"!%ortabile Ai 'in ae"t> a!z> n! ",a %rezentat la &e'i/
Pe lCn$> '!reri ea &ai %rezint> $re@!ri, 0>r">t!ri, "tare $eneral> alterat>,
an4ietate, e#alee, t!lb!r>ri 'e tranzit &ani#e"tate %rin on"ti%a@ie, #ebr> +B,+B,<
$ra'e C/
Se&ne obieti0e3
'!rere la %al%area #o"ei iliae 're%teL
"e&ne 'e irita@ie %eritoneal>L
"e&n!l -l!&ber$, '!rere e a%are la 'eo&%ri&area %eretel!i ab'o&inalL
"e&n!l Man'el 6al lo%o@el!l!i re%rezint> '!rere 0ie la %er!@ia #o"ei
iliae 're%te9L
a%>"are Ai ontra@ie &!"!lar> ab'o&en 'e le&nL
1i%ere"tezie !tanat>/
<7
Dn !r&a in0e"ti$a@iilor #>!te, %aienta e"te tran"%ortat> %e "e@ia 'e
1ir!r$ie #iin' "!%!"> inter0en@iei 1ir!r$iale Ai "tabilin'!,i,"e 'ia$no"ti!l 'e
%eritonit> a!t> 'at> 'e a%en'iit> %erorat>/
Antee'ente3
%er"onale3 la 0Cr"ta 'e E: ani a a0!t 1e%atit>/
<<
PLAN DE GNGRIHIRE PREOPERATOR
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
*,:<,2::) E/ Di"on#ort ab'o&inal 'in a!za
%roe"!l!i in#la&ator &ani#e"tat %rin
'!rere ?n #o"a ilai> 'rea%t> Ai
$re@!ri, 0>r">t!ri/
, A&eliorarea '!rerilor
ab'o&inale
, S> n! %rezinte $re@!ri,
0>r">t!ri/
, S> #ie e1ilibrat
1i'roeletroliti ?n E,2 zile/
, A"i$!rarea re%ao"!l!i ab"ol!t la %at ?n %ozi@ie ','
! a%!l ?ntr,o %arte/
, A%liarea !nei %!n$i 'e $1ea@> %e ab'o&en
, Reolteaz> "Cn$e %entr! e4a&enele 'e laborator/
, Pre$>tirea %aient!l!i %entr! inter0en@ia
1ir!r$ial>/
Paient!l %rezint> o
a&eliorare a "t>rii
$enerale/
2/ Re"%ira@ie "!%er#iial> a!zat> 'e
'!rere &ani#e"tat> %rin 'i"%nee
, Dnl>t!rarea 'i"%neei,
, A"i$!rarea !nei re"%ira@ii
nor&ale ?n ti&% 'e 27 ore/
, A"i$!rarea re%ao"!l!i ab"ol!t la %at ?n %ozi@ie
"e&iaAezCn'> "a! ',' ! a%!l ?ntr,o %arte, !
$en!n1ii #le4a@i/
, A%liarea !nei %!n$i 'e $1ea@> %e ab'o&en
, Aeri"irea a&erei Ai te&%erat!r> a'e0at>
, .4i$enotera%ie
Paient!l %rezint> o
re"%ira@ie nor&al>/
+/ Cir!la@ie &o'i#iat>, a!zat> 'e
'!rere, &ani#e"tat> %rin %!l" ra%i' Ai
"lab/
, Paient!l "> %rezinte o
ir!la@ie a'e0at>
, P!l"!l, TA "> aib> 0alori
nor&ale ?n ti&% 'e =,B ore
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
%!l"!l, TA, re"%ira@ia, 'i!reza Ai "e an!n@> &e'i!l
?n az!l &o'i#i>rii 0alorie/
, In#or&area bolna0!l!i a"!%ra "ta'i!l!i bolii "ale,
a"!%ra $ra'!l!i 'e e##ort %e are treb!ie ">,l
'e%!n>, a"!%ra i&%ortan@ei intr0en@iei 1ir!r$iale/
, 21ea@> %e ab'o&en, e#et!area %"i1otera%iei
Paient!l %rezint> o
ir!la@ie nor&al>, e"te
e1ilibrat %"i1i/
<=
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
7/ Ri" 'e 1i%erter&ie a!zat> 'e
in#e@ie &ani#e"tat> %rin reAterea
te&%erat!rii %e"te +) $ra'e C/
, Paient!l "> %rezinte
te&%erat!r> or%oral> ?n
li&itele nor&ale ?n ti&% 'e
7,= ore/
, A'&ini"trarea trata&ent!l!i ! antibiotie la
in'ia@ia &e'i!l!i/
, Folo"irea &i(loaelor antiin#la&atorii
ne&e'ia&entoa"e, %!n$a ! $1ea@>/
, Reoltarea %ro'!"elor %entr! e4a&en 'e laborator
6VSF, et/9
Paient!l n! e"te #ebril/
</ De"1i'ratare a!zat> 'e %roe"!l
in#e@io", &ani#e"tat> %rin 0>r">t!ri/
, Paient!l "> #ie e1ilibrat
1i'roeletri
, Paient!l "> aib> o "tare
'e on#ort #>r> $re@!ri Ai
0>r">t!ri ?n ti&% 'e B,E21
, Se 0a ?ntrer!%e ali&enta@i Ai &e'ia@ia oral>/
, I "e 0a #ae ree1ilibrarea 1i'roeletri> Ai
0ole&i>/
, Prin'erea !nei 0ene Ai in"talarea !nei %er#!zii/
Paient!l e"te e1ilibrat
1i'roeletri/
</ Ina%aitate 'e a "e ?n$ri(i "in$!r,
'atorat> '!rerii, &ani#e"tat> %rin
a"tenie, obo"eal>, "tare $eneral>
alterat>/
, Se 0a %re$>ti %aient!l 'in
%!nt 'e 0e'ere #izi Ai
%"i1i/
, Pre$>tirea %aient!l!i
%entr! o%era@ie/
, Pre$>tirea C&%!l!i
o%erator ?n ti&% 'e 271/
,Paient!l e"te a(!tat "> #a> baie ?n "%eial ?n zona
are treb!ie e4%lorat>/
, Va #i a(!tat "> ?&brae len(eria 'e "%ital
, Tran"%ort> %aient!l la "ala 'e o%era@ie/
, Re$i!nea !n'e !r&eaz> "> "e e#et!eze
inter0en@ia 1ir!r$ial> e"te "%>lat>, ra">,
'e$re"at>, 'ezin#etat> Ai a%oi ao%erit> ! !n
C&% "teril/
, Paient!l!i i ",a
realizat o b!n> %re$>tire
%reo%eratorie/
<)
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
=/ Fria 'e o%era@ie, a!zat> 'e
'!rere, &ani#e"tat> %rin "tare 'e
neliniAte, a$ita@ie/
, Pre$>tirea %aient!l!i
%entr! o%era@ie
, Pre$>tirea %aient!l!i
%entr! o%era@ie/
, Se &>"oar> Ai "e noteaz> ?n #oaia 'e ob"er0a@ie
%!l", re"%ira@ie Ai 'i!rez>/
, Se e#et!eaz> te"tarea la ana"tezie 64ilin>9
, C! +: &in ?nainte 'e inter0en@ie "e a'&ini"treaz>
la in'ia@ia &e'i!l!i Cte o #iol> 'e &ia$lin Ai
atro%in> i/0/
, e#et!area %"i1otera%iei/
, Paient!l!i I ",a e#et!at
o b!n> %re$>tire
%reo%eratorie/
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
E/ Ina%aitatea 'e a "e &iAa 'atorit>
e#et!>rii ane"tezi!l!i Ai o%era@iei
&ani#"tat> %rin a&e@eli, "o&nolen@>/
, Tran"%ortarea bolna0!l!i
! tar$a 'e la "ala 'e
o%era@ie ?n "alon Ai
in"talarea l!i ?n %at/
, Paient!l e"te a'!" 'e la "ala 'e o%era@ie ?n "alon
%rote(at 'e !n earAa#, Ai e"te in"talat ?n %at ?n
%ozi@ie ',' #>r> %ern> "!b a% Ai e"te "!%ra0e$1eat
ontin!!, !r&>rin'!,i,"e #!n@iile 0itale, %!l", TA,
re"%ira@ie, 'i!reza/
, S!%ra0e$1erea t!b!rilor 'e 'ren Ai raor'area lor
?ntr,!n rei%ient oletor/
, D!%> 27 ore 'e la ane"tezie bolna0!l e"te a(!tat ">
"e ri'ie ?n %ozi@ie "e&iaAezCn'> "a! AezCn'/
, Paient!l a!z>
"enza@ia 'e
a&e@eal> la
ri'iare Ai o !Aoar>
e#alee/
2/ D!reri a!te a!zate 'e inter0en@ia
1ir!r$ial> &ani#e"tate %rin neliniAte,
a$ita@ie/
, Paient!l "> %rezinte o
"tare 'e bine, #>r> '!reri/
, S>,Ai rea%ete ?nre'erea
?n #or@ele %ro%rii ti&% 'e 2,
+ zile/
, Cal&area '!rerii
, E#et!area %"i1o tera%iei/
, Cal&area '!rerii %rin a'&ini"trare 'e al&ante la
in'ia@ia &e'i!l!i/
, A"i$!rarea !n!i li&at ore"%!nz>tor
, A'&ini"trarea &e'ia@iei antiin#e@ioa"e/
UAoar> a&eliorare
a '!rerilor/
PLAN DE GNGRIHIRE POSTOPERATOR
<B
Da$a D%a/-"+$%' * -u(+%-/ O,%'$%!
I-$(!-;%%# a+%+$-$%: ("# p("p(%u =% ("#
*#/a$
E!a#ua(
7/ Di#i!ltate 'e a eli&ina, a!zat> 'e
inter0en@ia 1ir!r$ial>, &ani#e"tat>
%rin on"ti%a@ie, $re@!ri, 0>r">t!ri/
, Paient!l ">,Ai rea%ete
ontrol!l "#interelor/
, S> aib> o "tare 'e bine,
#>r> $re@!ri Ai 0>r">t!ri/
, Se 0a "er0i %aient!l ! bazinet/
, A'&ini"trarea 'e eai!ri la4ati0e/
, Re"%etarea re$i&!l!i %entr! %re0enirea
0>r">t!rilor/
, A"i$!rarea i$ienei '!%> #ieare eli&inare/
, S!%ra0e$1erea "a!n!l!i ?n antitate Ai alitate/
Prezint> "a!n
nor&al/
Ab"en@a
0>r">t!rilor/
</ Ina%aitatea 'e a "e ?n$ri(i "in$!r
a!zat> 'e inter0en@ie 1ir!r$ial>
&ani#e"tat> %rin %ozi@ie nea'e0at>,
'!rere/
, Paient!l "> %rezinte
&!oa"e Ai te$!&ente
!rate/
, S> %rezinte o "tare 'e
on#ort/
, E#et!area toaletei %ar@iale a %aient!l!i,
re"%etCn'!,I %!'oarea/
, S1i&barea len(eriei ori 'e Cte ori "e &!r'>reAte/
, S1i&barea %an"a&ent!l!i Cn' ae"ta "e
&!r'>reAte/
, S!%ra0e$1erea %an"a&ent!l!i Ai t!b!rilor 'e 'ren/
Paient!l %rezint>
&!oa"e Ai
te$!&ente !rate/
B/ An4ietate a!zat> 'e ne!noaAterea
%ro$no"ti!l!i bolii, &ani#e"tat> %rin
?n$ri(orare, in"o&nii/
, Di&in!area an4iet>@ii
%aient!l!i Ai atra$erea
aten@iei a"!%ra nor&elor 'e
0ia@> %e are treb!ie "> le
re"%ete/
, F!rnizeaz> %aient!l!i !noAtin@ele nee"are
'e"%re re$i&!l 'e 0ia@> are treb!ie ">,l '!>/
, E0itarea e#ort!rilor #izie %rea &ari/
Paient!l e"te
e1ilibrat %"i1i/
<*
CONCLUZII
1eritonita acuta 0 ln#la&atiile a!te ale %eritone!l!i a! ori$ini #oarte 'i#erite3
%er#orarea !n!i !ler al "to&a!l!i "a! al '!o'en!l!iL a%en'iitaL olei"tita
6in#la&atia 0ezi!lei biliare9L "i$&oi'ita 6in#la&atia !lti&ei %arti a olon!l!i9L
%la$a !n!i 0i"er a0itar, "!r0enita in !r"!l !n!i tra!&ati"& al ab'o&en!l!iL
"al%in$ita 6in#la&atia !neia "a! a&belor tro&%e !terine9L in ae"t !lti& az,
%eritonita ra&ane loalizata in &i!l bazin/
peritonita acuta poate fi generalizata sau localizata.
, . %eritonita a!ta $eneralizata "e tra'!e %rintr,o '!rere ab'o&inala inten"a
"i $eneralizata, %rin "e&ne 'e %aralizie inte"tinala 60ar"at!ri, o%rire a
e0a!arii &ateriilor #eale "i a $azelor9, %rintr,o alterare a "tarii $enerale
6#ebra, 'e%re"ie9 "i !neori %rin "e&ne ale &i"orarii 0ol!&!l!i "an$0in
6%aloare, an4ietate, %!l" ra%i'9/ M!"1ii %eretel!i ab'o&inal "!nt #oarte
ontratatiL %eretele ab'o&inal 'e0ine tare, ten"ionat, '!rero" 6ab'o&en 'e
le&n9/
0 . %eritonita a!ta loalizata antreneaza #or&area 'e a'erente are
o&%arti&enteaza a0itatea %eritoneala "i i&%ie'ia #oar!l in#etio" "a "e
intin'a/ Loalizarea "a 'e%in'e 'e or$an!l in a!za 6in (o" "i in 'rea%ta
ab'o&en!l!i %entr! a%en'iita, in (o" "i la "tan$a %entr! "i$&oi'ita9/
1eritonitele secundare %rezinta !nele arateri"tii 'atorate $er&enilor
'e%en'enti 'e or$an!l a#etat/ 2er&enii %ot onta&ina %eritone!l in !r&a
%er#oratiei trat!l!i $a"trointe"tinal, a #iat!l!i, olei"t!l!i, %anrea"!l!i,
"%linei, a%arat!l!i $enital "i !rinar "a! a !nor oletii intraab'o&inale, "a!
%ro0in 'e la a#eti!nile a!te in#etioa"e ale 0i"erelor intra%eritoneale/
Strangularea intestinului su$tire, 0ol0!l!"!l, in0a$inatia, "tran$!larea
1erniara interna "a! e4terna, in#art!l entero,&ezenteri, "e %ot "ol'a !
neroza %eretel!i inte"tinal "i %atr!n'erea in a0itatea %eritoneala a
=:
ontin!t!l!i inte"tinal/ Peritone!l %oate #i in#etat inaintea %er#oratiei %rin
tran"loatia bateriilor %rin %eretele alterat al inte"tin!l!i "tran$!lat in
ol!ziile "a! %"e!'o,ol!ziile olon!l!i, an' 0al0!la ileoeala e"te
o&%etenta, %er#oratia 'ia"tatia a e!l!i %oate #i a!za %eritonitei/
/raumatismele a$domenului, contuzii sau plagi, %ot #i in"otite 'e lezi!ni
0i"erale "i 'e %eritonite/ P(%$"-%$# p"+$"p(a$"(%% "!nt #re0ent 'atorate
lezi!nilor ana"to&otie, 'ar, "i "e!n'are onta&inarii %eritone!l!i ! bila,
"! %anreati, !rina, "an$e "a! or%i "traini/ D%f(%$# )a-!( (a*%"#"/%'
+au -*"+'"p%' %ot #i !r&ate 'e %eritonite/ I-f'$%%# a+'-*-$ a#
$(a'$u#u% /-%$a# f)%-%-3 !& ar #i ele $onooie "a! alte in#etii %el0iene
a "e%"i"!l %!er%eral, %ot #i a!za %eritonitelor/
Mortalitatea a re"!t "i 'atorita #a%t!l!i a %er#oratia "e intalne"te
#re0ent la %er"oane 0ar"tnie, are ab!zeaza 'e trata&ent!l !
antiin#la&atorii ne"teroi'iene/ In p(f"(a$%a u#'(u#u%, ontin!t!l trat!l!i
'i$e"ti0 "!%erior, bo$at in ai' lor1i'ri, %e%"ina, bila, enzi&e %anreatie,
e"te 'er"at in a0itatea %eritoneala/ Mo'i#iarile %eritoneale a%ar ra%i',
on"einta a !nei iritabile Kar"!ri 1i&ie interneNO/ Alterarea a%ilar!l!i
%er&ite &i$rarea in a0itatea %eritoneala 'e antitati &ari 'e li1i'e bo$ate in
%roteine, eea e '!e la "a'erea 0ol!&!l!i %la"&ati ! "e1e"trarea 'e
li1i'e in "%ati!l "!b%eritoneal 'e la ni0el!l 0i"erelor, "i are are 're%t
on"einta "a'erea intoarerii 0enoa"e la or'!l 're%t "i "a'erea 'ebit!l!i
ar'ia, "i a%aritia "o!l!i/ E"ti&area e'e&!l!i 0i"eral in ti&%!l inter0entiei
e"te in#erior el!i real, "%ati!l e4trael!lar %!tan' #i 'e 2,7 I/In %er#oratiile
'i$e"ti0e inalte, %ier'erea 'e li1i'e "i 'e eletroliti "!nt a%ro4i&ati0 e$ale !
e4e%tia #i"t!lelor %anreatie in are %ier'erile "!nt 1i%ertone/ Daa in
%ri&ele ore li1i'!l e a %atr!n" in a0itatea %eritoneala %oate #i on"i'erat
"teril, !lterior a%are "!%rain#etia bateriana, #ie %rin #lora e4i"tenta in li1i'!l
'e %er#oratie, #ie %rin treerea $er&enilor, are tra0er"eaza %eretele
inte"tin!l!i "a! 'in li&#atie/
=E
BIBLIOGRAFIE
C.RNELIU -.RUNDEL Man!al 'e &e'iin> intern> %entr! a're
&e'ii, -!!reAti, E**7
D/ VASILE, M/ 2RI2.RIU C1ir!r$ie, -!!reAti, E**<
MIFAI MIFYILESCU C1ir!r$ie %entr! a'rele &e'ii, -!!reAti,
E*)*
2E.R2ETA -ALTY Te1nia ?n$ri(irii bolna0!l!i, -!!reAti,
E*B+
EU2EN TARC.VEANU Te1nii 1ir!r$iale, E'it!ra Poliro&, Ia"i,
2::+
NIC.LAE AN2ELESCU Tratat 'e %atolo$ie 1ir!r$iala, E'it!ra
Me'iala, -!!re"ti, 2::+
=2