Peritonitis is an inflammation of the peritoneum membrane that lines the abdominal cavity. It can result from a rupture or perforation in the abdomen or from other medical conditions. Symptoms include abdominal pain, bloating, fever, and nausea. Treatment involves antibiotics and may require surgery to address the underlying cause. The prognosis depends on the number of organ systems affected, with higher organ failure associated with higher mortality rates.

1. PERITONITIS
By
Ameerbabu shaik
A1
16

2. INDEX:
• Indtroduction
• Symptoms
• Common causes
• Risk factors
• Diagnosis
• Scans
• Treatment plan
• Surgical plan
• prognosis
• Bibilography

3. What is Peritonitis
• Peritonitis is an inflammation of the peritoneum
• Peritonium is a membrane covered by a single sheet of mesothelial cells
,with an estimated area of 1.7 m2
• It can result from any rupture (perforation) in the abdomen or occur as a
complication of other medical conditions.
• Peritonitis may be primary (that’s occurring spontaneously and not as the
result of some other medical problem) or secondary (that’s resulting from
some other condition).
• It is most often due to infection by bacteria, but may also be due to some
kind of a chemical irritant. Sepsis is a life-threatening organ dysfunction
caused by a dysregulated host response to infection.

4. Types
• There are two types of peritonitis:
• Spontaneous bacterial peritonitis. Sometimes, peritonitis develops as a complication of
liver disease, such as cirrhosis, or of kidney disease.
• Secondary peritonitis. Peritonitis can result from rupture (perforation) in abdomen, or as
a complication of other medical conditions

5. Symptoms
• Abdominal pain or tenderness or rigidness (Most common symptom)
• Bloating or a feeling of fullness in your abdomen
• Fever
• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Low urine output
• Thirst
• Inability to pass stool or gas
• Fatigue
• Confusion

6. Common causes
• Medical procedures, such as peritoneal dialysis
• A ruptured appendix, stomach ulcer or perforated colon
• Pancreatitis.
• Diverticulitis.
• Trauma.

7. Risk factors
• Previous history of peritonitis
• History of alcoholism
• Liver disease
• Fluid accumulation in the abdomen
• Weakened immune system
• Pelvic inflammatory disease

8. Diagnosis
• Diagnosis is mainly based on clinical manifestations
• Abdominal rigidity (Most specific )
• Blood tests ( Leukocytosis, hypokalemia, hypernatremia, and acidosis may be present, but
they are not specific findings).
• Imaging tests (X-Ray,CT,MRI)
• Peritonialfuid analysis (Paracentasis )
• Exploratory surgery

9. X-ray CT scan MRI

10. Treatment plan
• We first start with medical management
• Antibiotics( Broad spectrum,cephalosporin,ampicillin,triglycine,tetracycline)
• Surgery (open or closed )

11. Goals of surgery
• To eliminate the source of contamination
• To reduce the bacterial inoculum
• To prevent recurrent or persistent sepsis
• Pre-operative
• Volume resuscitation and the prevention of secondary organ system dysfunction are of the
utmost importance in the treatment of patients
• placement of Foley catheters may be indicated to monitor urine output
• In patients with evidence of septic shock or altered mental status, intubation and ventilator
support should be considered at an early stage to prevent further decompensation.

12. • A vertical midline incision is the incision of choice in most patients with generalized peritonitis because
it allows access to the entire peritoneal cavity. In patients with localized peritonitis (like from (acute
appendicitis or cholecystitis), an incision directly over the site of the pathologic condition (for example
RLQ or right subcostal incision) is usually adequate.
• In cases where the etiology of the peritonitis is unclear, initial diagnostic laparoscopy may be useful
• Open abdomen vs closed abdomen Technique :
• The goal of the open-abdomen technique is to provide easy, direct access to the affected area. Source
control is achieved through repeated reoperations or through open packing of the abdomen
• It may be considered for elderly patients as well as for younger ones.
• The open-abdomen technique should also be considered in patients who are at high risk for the
development of abdominal compartment syndrome (ACS)
• The goal of the closed-abdomen technique is to provide definitive surgical treatment at the initial
operation. Primary fascial closure is employed, and repeat laparotomy is performed only when clinically
indicated.

13. • Pancreatitis-associated peritonitis :
• Patients may present with significant abdominal symptoms and a severe, systemic inflammatory
response, yet they may have no clear organ-specific indications for emergency exploration.
• Patients with pancreatitis-associated peritonitis may be best served by a period of 12-24 hours of
observation and intensive medical support
• Percutaneous treatment is reserved for the management of defined peripancreatic fluid collections in
stable patients.
• Pancreatic abscess or infected pancreatic necrosis generally should be treated with surgical
debridement and repeated exploration

14. Open-Abdomen Approach
• Second-look surgery:( planned )
• Staging may be performed as a scheduled second-look operation or through open
management, with or without temporary closure ( like with mesh or vacuum-assisted closure
[VAC])
• Second-look operations may be employed in a damage-control fashion.
• The goal of the initial operation is to provide preliminary drainage and to remove obviously
necrotic tissue. The patient is then resuscitated and stabilized in an intensive care unit (ICU)
setting for 24-36 hours and returned to the operating room for more definitive drainage and
source control

15. Laparoscopic Approach
• Laparoscopic surgery is commonly used in
the treatment of uncomplicated
appendicitis, though there is evidence to
indicate that it can yield positive outcomes
for complicated appendicitis as well.
• For both complicated and uncomplicated
appendicitis, the laparoscopic approach is
associated with a shorter length of hospital
stay and fewer wound infections than is the
open approach.
• However, laparoscopic surgery may be
associated with a higher rate of intra-
abdominal abscess.

16. Multiple Reexplorations:
• In severe peritonitis, particularly when it includes extensive retroperitoneal involvement (for example-
necrotizing pancreatitis), open treatment with repeat re-exploration, debridement, and intraperitoneal
lavage has been shown to be effective.
• Multiple reoperations may be associated with significant risks, including those from a substantial
inflammatory response, fluid and electrolyte shifts, and hypotension.
• Post operative care :
• Postoperatively, all patients should be closely monitored in the appropriate clinical setting for adequacy of
volume resuscitation, resolution or persistence of sepsis, and the development of organ system failure.
Appropriate systemic broad-spectrum antibiotic coverage must be continued without interruption for the
appropriate amount of time.
• All patients who are critically ill and patients who are receiving prolonged antibiotic therapy are at
increased risk for the development of secondary, opportunistic infections (eg, Clostridioides (Clostridium)
difficile colitis, fungal infections, central venous catheter infections, and ventilator-associated pneumonia).
Accordingly, they should be closely monitored for signs and symptoms of these complications

17. prognosis
• The average total mortality rate was 18.5%. The prognosis for patients
without organ failure or with failure of one organ system was excellent
(mortality rate, 0%); quadruple organ failure, however, had a mortality rate
of 90%.

18. Bibilography
• Wikipedia
• Medscape
• NCBI
• https://academic.oup.com/bjs/article/86/11/1371/6269196?login=true
• https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-
20376250
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459264/
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/peritonitis#