DIAGNOSIS

ANAMNESIS : nyeri abdomen, mual muntah, demam, dehidrasi, hipotensi, produksi urin
berkurang
PEMERIKSAAN FISIK
Vital sign

KEADAAN UMUM : tidak baik

DENYUT NADI : takikardi
PERNAFASAN :
SUHU : >38 c

Inspeksi
: perut membuncit dan tegang
Palpassi
: nyeri tekan dan defans muscular,nyeri somatik
Perkusi
: pekak hepar menghilang dan perkusi abdomen hypertimpani
Auskultasi : bising usus melemah atau menghilang sama sekali
PEMERIKSAAN RADIOLOGIS
Foto polos abdomen 3 posisi, yaitu :
1 tidur telentang (supine) sinar dari arah vertikel dengan proyeksi anteroposterior (AP) .
2 duduk atau setengah duduk atau berdiri kalau memungkinkan, dengan sinar horizontal proyeksi (AP)

DIAGNOSIS
HISTORY: abdominal pain, nausea and vomit, fever, dehydration, hypotension,
reduced urine production
PHYSICAL EXAMINATION:
VITAL SIGN

General state : bad

Pulse
: tachycardia
Breathing :
Temp : >38 c

INSPECTION : belly bulge and tense

PALPATION : tenderness and defense muscular, somatic pain
PERCUSSION : liver dullness disappear and hipertimpani on abdomens percussion
AUSCULTATION : bowel sounds weaken or disappear altogether

LABORATORY EXAMINATION:
Leukocytosis
Hematocrit
Metabolic acidosis

 RADIOLOGY EXAMINATION:
Foto Polos abdomen 3 posisi
1. Supine, beam from vertical direction with anteroposterior
projection (AP).
Preperitoneal fat disappear, psoas line disappear, opaque at abdominal
cavity

2. Sit or half-sit or stand position if necessary, with horizontal

beam projection (AP)
Subdiafragma free air which looks like crescent (semilunaris shadow)

3. Left lateral decubitus (LLD) with horizontal beam projection

(AP)
Intraperitoneal free air in the abdominal are which is the highest
located

 TREATMENT
Make gastrointestinal tract rest with:

Fasting
Decompression with nasogastric or intestinal suction
Replacement of fluid and electrolyte lost with intravenous
Proper antibiotic
Focus septic disposal (appendix) or other causes of inflammation
Removal pain procedure

Replacement of colloid fluid and electrolyte

Analgesic for pain
Antiemetic for nausea and vomit
Intubation and suction for distance of abdominal and increase gut
function
Surgery if there is appendicitis
Antibiotic

 Complication
In secondary acute bacterial peritonitis in which the complication divided into
early and further complication
Early complication

Septicemia and septic shock

Hypovolemic shock
Uncontrolled of Recurrent of intraabdominal septic with multi system failure
Residual abscess of intraperitoneal

Further complication
Adhesion
Intra recurrent of obstruction

Prognosis
For local and mild peritonitis the prognosis is well
On general peritonitis the prognosis could be deadly because of virulence of
organism