peritonitis (per?it-on-it'is) [ peritoneum + -itis]
Inflammation of the serous membrane that lines the abdominal cavity and its viscera. See: chemical peritonitis
; primary peritonitis
; secondary peritonitis
Peritonitis is caused by infection of the abdominal cavity without obvious organ rupture (primary peritonitis), by perforation (rupture) of one of the internal organs (secondary peritonitis), or by instillation of a chemical irritant into the abdominal cavity (chemical peritonitis).
Primary peritonitis occurs in patients with cirrhosis and ascites, in some patients with tuberculosis (esp. those with AIDS), and in patients who use the peritoneum for dialysis. Cirrhotic patients develop peritonitis from infection of the peritoneal contents by microorganisms such as Streptococcus pneumoniae, enterococci, or Escherichia coli. Patients who use the peritoneum for dialysis (chronic ambulatory peritoneal dialysis patients) sometimes contaminate their dialysate with hand-borne microbes such as staphylococci or streptococci. Dialysis patients may also develop peritonitis after the infusion of irritating substances (e.g., antibiotics like vancomycin) into the peritoneal cavity during treatment for these infections.
Common causes of secondary peritonitis are ruptured appendix, perforated ulcer, abdominal trauma, and Crohn's disease. The gases, acids, fecal material, and bacteria in the ruptured organs spill into and inflame the peritoneum.
Primary peritonitis is marked by moderate to mild abdominal pain, fever, change in bowel habits, and malaise. Dialysis patients may notice clouding of their discharged dialysate. Fever, weight loss, inanition, and other systemic symptoms are common in tuberculous peritonitis.
Secondary peritonitis is marked by intense, constant abdominal pain that worsens on body movement. It is often associated with nausea, loss of appetite, and fever or hypothermia. On examination the abdomen is typically distended and quiet, and the patient holds very still in order to limit discomfort.
In patients with organ rupture, a plain x-ray examination of the abdomen may reveal air trapped beneath the diaphragm. Ultrasonography or abdominal computed tomography is used to visualize intraperitoneal fluid, abscesses, and diseased organs. Paracentesis or peritoneal lavage are also helpful in the diagnosis of some cases.
Primary peritonitis may respond to the administration of antibiotics or antitubercular drugs, but the prognosis is guarded. Secondary peritonitis is treated with surgical drainage, repair or removal of the ruptured viscus, fluid resuscitation, and antibiotics. The prognosis depends on the patient's underlying condition, the rapidity of the diagnosis and of subsequent medical intervention, and the skill of the surgeon.
acute diffuse peritonitisDiffuse peritonitis.
Peritonitis characterized by the adherence of adjacent visceral and parietal surfaces.
Peritonitis due to causes other than bacterial, fungal, or viral infection (e.g., trauma, presence of chemicals produced naturally or introduced into the cavity, or irradiation).
benign paroxysmal peritonitis
An old term for familial Mediterranean fever. See: familial Mediterranean fever
Peritonitis caused by the escape of bile into the peritoneal cavity. It usually results from an injury to the gallbladder or bile ducts during cholecystectomy.
Peritonitis due to presence of chemicals (e.g., intestinal juices, pancreatic secretions, or bile) in the peritoneal cavity.
Peritonitis usually caused by tuberculosis or cancer. Findings include slight or absent fever, pain, diffuse tenderness, anemia, and emaciation.
circumscribed peritonitisLocalized peritonitis.
Chronic peritonitis with a thickened membrane and adhesions that contract and cause retraction of the intestines.
Peritonitis in which the peritoneal surface of the diaphragm is mainly affected.
Peritonitis that is widespread, involving most of the peritoneum. Synonym: generalized peritonitis
Peritonitis with fibrosis and caseation, usually caused by tuberculosis.
1. Peritonitis in which gas is present in the peritoneal cavity.
2. Peritonitis caused by group A streptococci (GAS).
generalized peritonitisDiffuse peritonitis.
Peritonitis confined to the area immediately surrounding an abscess, inflamed organ, or leak. Synonym: circumscribed peritonitis
Peritonitis in the newborn caused by perforation of the gastrointestinal tract in utero. It most often occurs in newborns with cystic fibrosis. Neonatal intestinal obstruction is also usually present.
Peritonitis involving the peritoneum of the pelvis, usually as a result of endometrial, tubal, or ovarian infections.
periodic peritonitisFamilial Mediterranean fever.
Peritonitis resulting from infectious organisms transmitted through blood or lymph.
Peritonitis that develops after childbirth.
Peritonitis resulting from extension of infection from adjoining structures, rupture of a viscus, abscess, or trauma.
Peritonitis caused by a pyogenic bacterium.
Peritonitis in which there is copious liquid exudation.
Peritonitis in which there are no signs or symptoms.
Peritonitis due to particles of talcum powder in the peritoneal cavity (e.g., postoperatively).
Acute peritonitis due to injury or wound infection.
Peritonitis caused by tuberculosis.