Prognosis in generalised peritonitis - Apache-II score

Praveenkumar, - (2013) Prognosis in generalised peritonitis - Apache-II score. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Peritonitis is the major cause for mortality and morbidity. Even though with adequate antibiotics coverage, adequate medical support peritonitis is supposed to be dominating cause for deaths. Now-a-days since there is life style modification, sedentary work habits, higher calory intake, and consumption of alcohol and smoking have greatly increased chances of risk for mortality and morbidity. Various disease can be evaluated with various clinical scaling for example Ransons criteria for acute pancreatitis. Similarly certain indices can be used for evaluation of generalised peritonitis. One such a method is APACHE-II scoring. This helps in assessing the outcome of patients treated with peritonitis. AIM OF THE STUDY: An study conducted on patients with generalised peritonitis with following aims: a) To evaluate the incidence of mortality rate in generalised peritonitis in TVMCH, Tirunelveli. b) To implement APACHE-II in assessing the degree of severity of generalised peritonitis. c) To find out the contributing factors for deaths in generalised peritonitis. METHOD OF STUDY AND MATERIALS: The APACHE –II study was done in tirunelveli medical college and hospital, Tirunelveli. The main aim was to study the risk factor, aetiology, and APACHE – II scoring. In this prospective study we used 100 patients suffering with generalized peritonitis who were admitted in general surgical wards. The study was undertaken between 12/08/2011 to 12/08/2012. Selection criteria done by random samples. The selected patients are all established cases of peritonitis which includes are gastric perforation , duodenal perforation, small bowel perforation, large bowel, appendicular perforation, post surgical leakage, liver abscess, pancreatitis and others using variety of clinical data, ultrasound guided findings of intraabdominal collection and post surgical collection of free pus or gastric / intestinal contents in the abdomen. Thus we made conclusive diagnosis based on following datas. Cases of appendicitis are added in this study provided there is presence of free fluid inside peritoneum with peritonitis. Genitourinary and gynaecological cases were excluded from the study. These patients were treated intensively with antibiotics which covers aerobic and anerobic organism. From 100 cases we took 91 cases for emergency operation. We managed 9 cases conservatively by keeping bilateral flank drain because 3 patients were not willing for surgery and 6 patients were unfit for operation. Among 91 patients operated 4 patients died and out of 9 patients not operated 6 patients died and 3 patients recovered. RESULTS: This study includes 100 patients with intra abdominal sepsis (86 males and 14 females). The overall mortality in this study was 10%. Table No. 1 shows the Age and Sex distribution of the cases in the present study. Males accounted for 86% of the cases while females accounted for 14%, the sex ratio being 6.1:1 (M:F). The maximum number of patients were In the age group of 30-39 years (31%) followed by those in 40-49 years group (20%) and 20-29 years group (17%). CONCLUSION: This prospective study was conducted in Tirunelveli Medical College Hospital, Tirunelveli during the 2011 to 2012. A total of 100 patients with proved intra abdominal who were admitted to general surgery wards during this period were included in this study. The mean age of the patients was 40.6 years and the overall mortality was 10 %. The mean age of the patients who expired was 49.7 years. Patients above the cut of age of 40 years had a significantly higher mortality of 16.3% as compared to 5.3% among these below 40 years. Duration of illness had a definite influence on the outcome of the disease. An early surgical intervention had a favorable effect with CFR as low as 1.4% in those who were operated within 24 hours of the onset of illness. Dalayed surgical intervention significantly raised the CFR to 32.1%. The cause of peritonitis also had its share of contribution in the outcome of the disease.CFR increased as the cause of peritonitis went down the gastrointestinal tract starting with 10.1 % due to gastroduodenal cause and increasing to 13.3% due to causes in small beowel. There was no mortality in patients with appendicular pathology through the number of patients is very small to draw any conclusion. No conclusion could be drawn regarding mortality in patients with large bowel pathology as there was only 1 patient in this group out of the 100 patients studied. Similary nothing could be concluded regarding mortality due to post operative, pancreatic and primary causes as there were no patients in this study with such pathology. The APACHE II Score was a very clear and significant indicator of the outcome of intra abdominal sepsis. Patients with an APACHE II Score more than 15 had 88.9% compared to 2.2% in those who had APAHCE II Score less than15. The higher CFR in patients with APACHE II Score more than 15 is constant with the results of other studies conducted previously. No conclusion could be drawn regarding the effect of other risk factors like DM, chronic respiratory and renal diseases on the outcome of patients with intra abdominal sepsis as none of the patients in this study had such risk factors. In the end it can be stated that APACHE II Score, which is a reflection of the effect of various risk factors on the disease process in an individual, is a reliable indicator of the possible outcome in patients with intra abdominal sepsis. However the number of patients studied in this series as such is small compared to the high incidence of peritonitis and a larger number of patients need to be studied to come to a definite and statistically significant conclusion.

Item Type: Thesis (Masters)
Uncontrolled Keywords: generalised peritonitis, Prognosis, Apache-II score.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:43
Last Modified: 13 Jan 2020 13:46

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