1. Acute Peritonitis : Etiology
Name : Vihari Vichakshana
Rajaguru Group : No 32
4th
year 2nd
semester
2. What’s peritoneum ?
• Made of mesothelium.
• Largest cavity in the body
• Composed of flattened polyhedral cells,
resting on fibro-elastic membrane.
• Beneath the peritoneum lies loos areolar
tissue which has rich supply of capillaries
and lymphatics.
3.
4. Introduction
• Defined as inflammation of the peritoneum.
• May be localized or generalized.
• In most cases there is bacterial invasion
hence when it is said that there is peritonitis
Bacterial peritonitis.
• Even in patients with non bacterial
peritonitis like those d/t Pancreatitis
Eventually gets infected d/t transmural
spread from the gut.
7. Microbiological aspect
• Peritoneal infection is usually caused by more than 2
strains of bacteria.
• Gram negative endotoxins (lipopolysaccharides)
TNF
Endotoxic shock
Tissue perfusion
• These organisms are present in the lower GI tract
and do respond to Penicillins rather to metronidazole
and clindamycin and cephalosporins
8. Non gastrointestinal causes
• Pelvic infection via fallopian tubes are one of the
major causes of Non GI cause of peritonitis.
• The most common organisms being Chlamydia
or gonococcus.
• Chlamydia Fitz Hugh Curtis Syndrome
(perihepatitis)
• Fungal Peritonitis In severely ill patients or
Immuno-compramised patients.
10. Localized Peritonitis
• Anatomical and pathological factors help confining infection
to localized areas.
• Greater sac is divided into
– Subphrenic space
– The pelvis
– Peritoneal cavity proper.
• Supracolic and infracolic (division by transverse colon and
transverse mesocolon)
• When supracolic compartment overflows, it does so over to
infracolic region/paracolic gutters/pelvis.
11. Peritoneum
• Inflammed peritoneum loses sheen
Fibrin
• Flakes of fibrin appear loops of intestine
become adherent to each other
Leukocytes
• Outpouring of serous fluid rich in leukocytes which later
becomes frank pus Ileus Prevents spread of
infection
Greater omentum seals the area.
12. Diffuse peritonitis
• Factors favoring spread of peritonitis.
– Speed of peritoneal contamination
– Ingestion of food.
– Virulence of infecting organism
– Young children with small omentum.
– Disruption of localized collection
– Immune deficiency
• With appropriate treatment localized disease
will resolve
– About 20% progress to abscess.