Peritonitis Disease

DESCRIPTION

Acute inflammation of the visceral and parietal peritoneum

System(s) affected: Gastrointestinal, Endocrine/Metabolic, Cardiovascular
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Common
Predominant age: None
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Acute abdominal pain
Fever
Nausea
Vomiting
Constipation
Abdominal pain exacerbated by motion
Abdominal distention
Dyspnea
Diffuse abdominal rebound
Generalized abdominal rigidity
Decreased bowel sounds
Abdominal hyper-resonance to percussion
Hypotension
Tachycardia
Tachypnea
Dehydration
Ascites

CAUSES

Primary – spontaneous bacterial peritonitis
- Ascites associated with cirrhosis
- Ascites associated with nephrotic syndrome
Secondary
- Following abdominal trauma
- Penetrating wounds
- Continuous ambulatory peritoneal dialysis
- Perforation of bowel
- Appendicitis
- Colitis – infectious or inflammatory
- Peptic ulcer perforation
- Gangrene of the bowel
- Diverticulitis
- Pancreatitis
- Postoperative (intra-abdominal surgery)
- Acute cholecystitis

RISK FACTORS

Recent surgery
Cirrhosis, frequently secondary to alcoholism
Corticosteroid medication
Nephrotic syndrome
Continuous ambulatory peritoneal dialysis

LABORATORY

Positive culture of peritoneal aspirate
Leukocytosis
Increased BUN
Hemoconcentration
Positive blood culture
Metabolic acidosis
Respiratory acidosis
Elevated amylase
Ascitic fluid analysis

Drugs that may alter lab results: Antibiotics prior to blood studies
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Peritoneum – generalized fibrinopurulent exudate
Peritoneum – polymorphonuclear infiltration

SPECIAL TESTS

N/A

IMAGING

Abdominal film: free air in the peritoneal cavity, large bowel dilatation, small bowel dilatation, intestinal wall edema
Chest x-ray: elevated diaphragm
CT: intra-abdominal mass, ascites
Sonograph: intra-abdominal mass, ascites

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Inpatient with intensive care as indicated

GENERAL MEASURES

Treat paralytic ileus (nasogastric decompression)
Treat dehydration
Antibiotics are started empirically to cover a broad spectrum of organisms. The choice of antibiotic may be altered after culture results are obtained.
Respiratory support if needed
IV fluids
Blood transfusions (sometimes)

SURGICAL MEASURES

Treat underlying condition(s) and infection (by surgery if necessary)

ACTIVITY

Bedrest until infection is under control

DIET

IV fluids and electrolytes
Oral feedings only after return of bowel sounds and passage of flatus and/or feces
Total parenteral nutrition may be necessary

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE

Prophylactic antibiotics during abdominal surgery

POSSIBLE COMPLICATIONS

Hypovolemic consequences
Septicemia
Septic shock
Acute renal failure
Acute respiratory insufficiency
Liver failure
Abscess formation

EXPECTED COURSE AND PROGNOSIS

Fully developed paralytic ileus requires approximately 48 hours for recovery
Mortality depends on age, duration, cause, and pre-existing conditions

ASSOCIATED CONDITIONS

Abscesses: subdiaphragmatic, subhepatic, peritoneal, pelvic
Ileus

AGE-RELATED FACTORS

Pediatric: Get pediatric and surgical consultation, if available
Geriatric: Mortality greater in this age group. Symptoms may be muted.
Others: N/A

PREGNANCY

Ruptured ectopic pregnancy may lead to peritonitis

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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