acute diffuse peritonitis

acute diffuse peritonitis

Etymology: L, diffundere, to pour out; Gk, peri, near, tenein, to stretch, itis, inflammation

an acute widespread attack of peritonitis affecting most of the peritoneum and usually caused by infection or by a perforation of an abdominal organ (e.g., stomach or appendix). It is also a complication of peritoneal dialysis. Also called generalized peritonitis.

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

Etiology

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 fever

bile 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.

peritonitis

inflammation of the peritoneum. The cause may be infectious or chemical. Typical signs are rigidity and pain on palpation of the abdominal wall, absence of feces, severe toxemia and fever. In horses there is a mild colic and in dogs and cats there is often effusion. Paracentesis may show evidence of inflammation.

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acute diffuse peritonitis

in the early stages pain is evident all over the abdomen. There is soon a disappearance of pain, a profound toxemia develops and the disease may go undetected.

acute local peritonitis

added to the usual signs there is a sharp pain response over the site of the lesion.

adhesive peritonitis

peritonitis characterized by adhesions between adjacent serous structures.

aseptic peritonitis

see chemical peritonitis (below).

biliary peritonitis, bile peritonitis

that due to the presence of bile in the peritoneum; choleperitoneum. Is detected by the color of the fluid withdrawn by paracentesis. See also bile peritonitis.

chemical peritonitis

may be caused by leakage of bile, urine, gastric juices or pancreatic enzymes in acute pancreatitis. Infusion of irritant materials can cause a similar chemical irritation.

chronic peritonitis

is manifested by chronic toxemia, bouts of colic due to adhesions and an accumulation of exudate which may cause a visible distention of the abdomen. See also retroperitoneal abscess.

chylous peritonitis

an uncommon result of abdominal trauma or tumors, intestinal obstruction or lymphangiectasia.

egg peritonitis

peritonitis in birds due to release of an egg into the peritoneal cavity with subsequent infection by Escherichia coli which have ascended via the oviduct.

feline infectious peritonitis (FIP)

see feline infectious peritonitis.

idiopathic peritonitis

one caused by a primary infection of the peritoneal cavity, e.g. feline infectious peritonitis, or hematogenous spread from a noncontiguous site.

post-stripping peritonitis

fatal peritonitis occurring in cultured salmonid fish soon after stripping, sometimes before. Caused by a number of gram-positive cocci and coccobacilli; Carnobacterium piscicola considered to be the most important infection.

primary peritonitis

see idiopathic peritonitis (above).

septic peritonitis

secondary to disruption of the abdominal cavity or a hollow viscus, particularly leakage from the gastrointestinal tract.

silent peritonitis

asymptomatic peritonitis.

starch granulomatous peritonitis

talcum powder, and to a lesser extent, other powders used on surgical gloves can cause a granulomatous reaction on the peritoneum.

traumatic peritonitis

perforation of the gut wall or abdominal wall introducing infection into the peritoneal cavity. May result from stake or bite wound, inexpert passing of urinary or insemination catheter, sadistically by a broom handle in the vagina, or stabbing of the rumen as an emergency measure in acute ruminal tympany. See also traumatic reticuloperitonitis.

urine peritonitis

prolonged exposure of the peritoneum to urine, usually due to leakage from the bladder or a ureter, results in a peritonitis and the development of uremia. Bacterial infection may also be introduced.