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 peritonitisEtiology
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.
Symptoms
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.
Diagnosis
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.
Treatment
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 peritonitis
Diffuse peritonitis.adhesive peritonitis
Peritonitis characterized by the adherence of adjacent visceral and parietal surfaces.
aseptic peritonitis
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 feverbile peritonitis
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.
chemical peritonitis
Peritonitis due to presence of chemicals (e.g., intestinal juices, pancreatic secretions, or bile) in the peritoneal cavity.
chronic peritonitis
Peritonitis usually caused by tuberculosis or cancer. Findings include slight or absent fever, pain, diffuse tenderness, anemia, and emaciation.
circumscribed peritonitis
Localized peritonitis.peritonitis deformans
Chronic peritonitis with a thickened membrane and adhesions that contract and cause retraction of the intestines.
diaphragmatic peritonitis
Peritonitis in which the peritoneal surface of the diaphragm is mainly affected.
diffuse peritonitis
Peritonitis that is widespread, involving most of the peritoneum. Synonym: generalized peritonitis
fibrocaseous peritonitis
Peritonitis with fibrosis and caseation, usually caused by tuberculosis.
gas peritonitis
1. Peritonitis in which gas is present in the peritoneal cavity.
2. Peritonitis caused by group A streptococci (GAS).
generalized peritonitis
Diffuse peritonitis.localized peritonitis
Peritonitis confined to the area immediately surrounding an abscess, inflamed organ, or leak. Synonym: circumscribed peritonitis
meconium 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.
pelvic peritonitis
Peritonitis involving the peritoneum of the pelvis, usually as a result of endometrial, tubal, or ovarian infections.
periodic peritonitis
Familial Mediterranean fever.primary peritonitis
Peritonitis resulting from infectious organisms transmitted through blood or lymph.
puerperal peritonitis
Peritonitis that develops after childbirth.
secondary peritonitis
Peritonitis resulting from extension of infection from adjoining structures, rupture of a viscus, abscess, or trauma.
septic peritonitis
Peritonitis caused by a pyogenic bacterium.
serous peritonitis
Peritonitis in which there is copious liquid exudation.
silent peritonitis
Peritonitis in which there are no signs or symptoms.
talc peritonitis
Peritonitis due to particles of talcum powder in the peritoneal cavity (e.g., postoperatively).
traumatic peritonitis
Acute peritonitis due to injury or wound infection.
tuberculous peritonitis
Peritonitis caused by tuberculosis.
