inflammation of the peritoneum

1. PERITONITS

2. DEFINITION
•PERITONITIS :IS AN INFLAMMATION
(IRRITATION) OF THE PERITONEUM, THE
THIN TISSUE THAT LINES THE INNER WALL
OF THE ABDOMEN AND COVERS MOST OF
THE ABDOMINAL ORGANS

3. ETIOLOGICAL FACTORS
• BACTERIAL INFECTION: INCLUDES GRAM-NEGATIVE BACILLI
(E.G., ESCHERICHIA COLI)
• MEDICAL PROCEDURES, SUCH AS PERITONEAL DIALYSIS.
PERITONEAL DIALYSIS USES TUBES (CATHETERS) TO REMOVE WASTE
PRODUCTS FROM YOUR BLOOD WHEN YOUR KIDNEYS CAN NO
LONGER ADEQUATELY DO SO. AN INFECTION MAY OCCUR DURING
PERITONEAL DIALYSIS DUE TO UNCLEAN SURROUNDINGS, POOR
HYGIENE OR CONTAMINATED EQUIPMENT.
• A RUPTURED APPENDIX, STOMACH ULCER OR PERFORATED COLON.
ANY OF THESE CONDITIONS CAN ALLOW BACTERIA TO GET INTO THE
PERITONEUM THROUGH A HOLE IN YOUR GASTROINTESTINAL TRACT.

4. ETIOLOGICAL FACTORS
• PANCREATITIS. INFLAMMATION OF YOUR PANCREAS (PANCREATITIS)
COMPLICATED BY INFECTION MAY LEAD TO PERITONITIS IF THE
BACTERIA SPREAD OUTSIDE THE PANCREAS.
• DIVERTICULITIS. INFECTION OF SMALL, BULGING POUCHES IN YOUR
DIGESTIVE TRACT (DIVERTICULITIS) MAY CAUSE PERITONITIS IF ONE
OF THE POUCHES RUPTURES, SPILLING INTESTINAL WASTE INTO
YOUR ABDOMEN.
• TRAUMA. INJURY OR TRAUMA MAY CAUSE PERITONITIS BYALLOWING
BACTERIA OR CHEMICALS FROM OTHER PARTS OF YOUR BODY TO
ENTER THE PERITONEUM.EG:ACCIDENT.

5. ETIOLOGICAL FACTORS
• FECAL PERITONITIS: RESULTS FROM THE PRESENCE
OF FAECES IN THE PERITONEAL CAVITY. IT CAN RESULT
FROM ABDOMINAL TRAUMAAND OCCURS IF THE LARGE
BOWEL IS PERFORATED DURING SURGERY.
• FOREIGN BODY: PERITONITIS MAYALSO BE CAUSED BY
THE RARE CASE OF A STERILE FOREIGN BODY
INADVERTENTLY LEFT IN THE ABDOMEN AFTER SURGERY
(E.G., GAUZE, SPONGE ).

6. RISK FACTORS
• PREVIOUS HISTORY OF PERITONITIS
• HISTORY OF ALCOHOLISM
• LIVER DISEASE
• FLUID ACCUMULATION IN THE ABDOMEN
• WEAKENED IMMUNE SYSTEM
• PELVIC INFLAMMATORY DISEASE

7. PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS
INFLAMMATION OF THE PERITONEAL CAVITY
ABCESS OF INFECTION-DUE TO INFLAMMATION
DEATH IN SEVERE CASES

8. CLINICAL FEATURES
• THE BLUMBERG SIGN (A.K.A. REBOUND TENDERNESS, MEANING THAT
PRESSING A HAND ON THE ABDOMEN ELICITS LESS PAIN THAN
RELEASING THE HAND ABRUPTLY, WHICH WILL AGGRAVATE THE PAIN,
AS THE PERITONEUM SNAPS BACK INTO PLACE).
• DIFFUSE ABDOMINAL RIGIDITY ("ABDOMINAL GUARDING") IS OFTEN
PRESENT, ESPECIALLY IN GENERALIZED PERITONITIS
• FEVER
• SINUS TACHYCARDIA
• DEVELOPMENT OF ILEUS PARALYTICUS (I.E., INTESTINAL PARALYSIS),

9. CLINICAL FEATURES
• TENDERNESS IN YOUR ABDOMEN
• PAIN IN YOUR ABDOMEN THAT GETS MORE INTENSE WITH
MOTION OR TOUCH
• ABDOMINAL BLOATING OR DISTENTION
• NAUSEAAND VOMITING
• DIARRHEA
• CONSTIPATION OR THE INABILITY TO PASS GAS

10. CLINICAL FEATURES
• MINIMAL URINE OUTPUT
• ANOREXIA, OR LOSS OF APPETITE
• EXCESSIVE THIRST
• FATIGUE
• FEVER AND CHILL

11. DIAGNOSTIC EVALUATION
• BLOOD TESTS. A SAMPLE OF YOUR BLOOD MAY BE DRAWN AND SENT TO A LAB TO
CHECK FOR A HIGH WHITE BLOOD CELL COUNT. A BLOOD CULTURE ALSO MAY BE
PERFORMED TO DETERMINE IF THERE ARE BACTERIA IN YOUR BLOOD.
• IMAGING TESTS. YOUR DOCTOR MAY WANT TO USE AN X-RAY TO CHECK FOR HOLES
OR OTHER PERFORATIONS IN YOUR GASTROINTESTINAL TRACT. ULTRASOUND MAY
ALSO BE USED. IN SOME CASES, YOUR DOCTOR MAY USE A COMPUTERIZED
TOMOGRAPHY (CT) SCAN INSTEAD OF AN X-RAY.
• PERITONEAL FLUID ANALYSIS. USING A THIN NEEDLE, YOUR DOCTOR MAY TAKE A
SAMPLE OF THE FLUID IN YOUR PERITONEUM (PARACENTESIS), ESPECIALLY IF YOU
RECEIVE PERITONEAL DIALYSIS OR HAVE FLUID IN YOUR ABDOMEN FROM LIVER
DISEASE. IF YOU HAVE PERITONITIS, EXAMINATION OF THIS FLUID MAY SHOW AN
INCREASED WHITE BLOOD CELL COUNT, WHICH TYPICALLY INDICATES AN INFECTION
OR INFLAMMATION. A CULTURE OF THE FLUID MAYALSO REVEAL THE PRESENCE OF

12. DIAGNOSTIC PROCEDURE
• INCREASED WBC. THE WHITE BLOOD CELL COUNT IS ALMOSTALWAYS
ELEVATED.
• SERUM ELECTROLYTE STUDIES. SERUM ELECTROLYTE STUDIES MAY REVEAL
ALTERED LEVELS OF POTASSIUM, SODIUM,AND CHLORIDE.
• ABDOMINAL XRAY. AN ABDOMINAL XRAY MAY SHOW AIR AND FLUID LEVELS AS
WELLAS DISTENDED BOWEL LOOPS.
• ABDOMINAL ULTRASOUND. ABDOMINAL ULTRASOUND MAY REVEALABSCESSES
AND FLUID COLLECTIONS.
• CT SCAN. A CT SCAN OF THE ABDOMEN MAY REVEALABSCESS FORMATION.
• MRI SCAN .MRI MAY BE USED FOR DIAGNOSIS OF INTRA-ABDOMINALABSCESSES.
• PERITONEAL FLUID ANALYSIS. EXAMINATION OF THIS FLUID MAY SHOW AN
INCREASED WHITE BLOOD CELL COUNT, WHICH TYPICALLY INDICATES AN
INFECTION OR INFLAMMATION.A CULTURE OF THE FLUID MAYALSO REVEAL THE
PRESENCE OF BACTERIA.

13. MEDICAL TREATMENT
• FLUID. THE ADMINISTRATION OF SEVERAL LITERS OF AN ISOTONIC SOLUTION IS
PRESCRIBED.
• ANALGESICS. ANALGESICS ARE PRESCRIBED FOR PAIN.
• INTUBATION AND SUCTION. INTESTINAL INTUBATION AND SUCTION ASSIST IN
RELIEVING ABDOMINAL DISTENTION AND IN PROMOTING INTESTINAL FUNCTION.
• OXYGEN THERAPY. OXYGEN THERAPY BY NASAL CANNULA OR MASK GENERALLY
PROMOTESADEQUATE OXYGENATION.
• ANTIBIOTIC THERAPY. ANTIBIOTIC THERAPY IS INITIATED EARLY IN THE
TREATMENT OF PERITONITIS.