Vernix Caseosa Adalah

Idris Setiadi Lubis

09/280447/KU/13049
15308
Peritonitis
 Definisi
Peritonitis is an inflammatory condition of
the peritoneum; it may be infective or
noninfective. Intra-abdominal infections
have two major manifestations: bacterial
peritonitis and, its late but localized stage,
intra-abdominal abscess.
 Etiologi dan klasifikasi
Bacterial peritonitis can be classified as primary
and secondary peritonitis. Primary peritonitis is
usually defined as a diffuse bacterial infection of
the peritoneal cavity occurring without loss of
integrity of the digestive tract. Secondary
bacterial peritonitis is defined as an acute
infection of the peritoneal cavity, usually
resulting from perforation or anastomotic
disruption of the digestive tract (2)..
 Sometimes secondary peritonitis may
arise from acute abdominal inflammatory
conditions, peritoneal dialysis, and
systemic infections such as tuberculosis.
Noninfective peritonitis may result from
sterile involvement of the peritoneum such
as in eosinophilic peritonitis (3) or
encapsulating peritoneal sclerosis (4). It
may also be due to chemical peritoneal
irritation as in biliary or vernix caseosa
 Manifestasi klinis
The clinical diagnosis of peritonitis is
based on acute abdominal pain,
abdominal tenderness and guarding,
fever, tachycardia, nausea, vomiting, and
bloating; laboratory data such as
leukocytosis and acidosis are supportive
 Tampakan Radiologis
On MDCT, normal peritoneum appears as
a fine, thin structure, and therefore it is
hardly detectable. The pathologic
involvement produces a thickening of the
peritoneal layers, which become easily
noticeable.
 Tampakan Radiologis
According to the type of peritoneal
involvement, it is possible to identify three
different patterns
Smooth uniform pattern
Irregular pattern
Nodular pattern
 Smooth uniform pattern
peritoneal thickening is regular and of uniform
thickness and shows a smooth interface with
the omental fat
A 65-year-old man with hepatitis
induced liver cirrhosis, fever, and
abdominal pain. Axial contrast-
enhanced MDCT image (a) and
schematic drawing (b) show
smooth, uniform thickening of the
peritoneum (arrows) due to
spontaneous bacterial peritonitis.
 Irregular pattern
Peritoneal thickening shows a nonuniform
thickness with focal segments being thicker
than others; the interface between the
thickened peritoneum and the omental fat
appears rough and irregular; focal thicker
segments show an obtuse angle with the
peritoneum
A 34-year-old man with HIV
infection. Axial contrast-
enhanced MDCT
image (a) and schematic
drawing (b) show irregular
thickening of the
peritoneum (arrows) due to
proven tuberculous
peritonitis.
 Nodular pattern
peritoneal thickening is absent or minimal; the
predominant finding is well-defined nodules of
soft tissue attenuation which are individually
seen along the peritoneum and are outlined by
the adjacent omental fat; nodules typically show
variable diameters with some larger and others
smaller in size
A 42-year-old immigrant woman
from Ethiopia. Axial contrast-
enhanced MDCT image (a) and
schematic drawing (b) show
nodular thickening of the
peritoneum (arrows) due to proven
tuberculous peritonitis.
 Management
1) drainage of abscesses or infected fluid
collections;
2) dbridement of necrotic or infected
tissues; and
3) definitive measures to control the
source of contamination and to restore
anatomy and function.
 Daftar Pustaka
Peritonitis
S. I. Vas, D. E. Low, D. G. Oreopoulos
http://
www.nhs.uk/conditions/Peritonitis/Pages/I
ntroduction.aspx
R Heemken, L Gandawidjaja, T Hau -
Hepato-gastroenterology, 1996