Peritonitis is an infection or inflammation of the peritoneum, the membrane lining the abdominal cavity. There are two major types - primary peritonitis caused by spread of infection through the bloodstream and secondary peritonitis caused by a rupture or leak in the gastrointestinal or biliary tract. Symptoms include abdominal pain and tenderness, fever, nausea, and difficulty breathing. Treatment involves antibiotics, surgery to address the infection source, pain medication, and IV fluids. With treatment, prognosis depends on the underlying cause but untreated peritonitis is often fatal.

1. PERITONITIS
Tammy McDaniel & Emily Stevens
Evaluation of Athletic Injuries I
AH 322
September 29, 2003

3. Peritonitis (pear-ih-tuh-NYE-tis)
Infection, or rarely some other type of
inflammation, of the peritoneum.
Peritoneum is a membrane that covers the
surface of both the organs that lie in the
abdominal cavity and the inner surface of
the abdominal cavity itself.

4. Intra-abdominal infections result in
2 major clinical manifestations
• Early or diffuse infection results in localized or
generalized peritonitis.
• Late and localized infections produces an intra-
abdominal abscess.

5. 2 Major Types
• Primary: Caused by the spread of an infection
from the blood & lymph nodes to the peritoneum.
Very rare < 1%
• Usually occurs in people who have an
accumulation of fluid in their abdomens (ascites).
• The fluid that accumulates creates a good
environment for the growth of bacteria.

6. • Secondary: Caused by the entry of bacteria or
enzymes into the peritoneum from the
gastrointestinal or biliary tract.
• This can be caused due to an ulcer eating its way
through stomach wall or intestine when there is a
rupture of the appendix or a ruptured diverticulum.
• Also, it can occur due to an intestine to burst or
injury to an internal organ which bleeds into the
internal cavity.
2nd Type:

7. Both cases are very serious &
can be life threatening if not
treated properly!!!

8. • Hollow organs are more susceptible to
athletic injury when they are full of waste &
food products.
• Injury to a hollow organ may so signs of:
> black tarry stool
>bright red blood in the fecal discharge
>bloody vomitus
* Always remember there may be referred
pain.

9. Signs & Symptoms
• Swelling & tenderness in
the abdomen
• Fever & Chills
• Loss of Appetite
• Nausea & Vomiting
• ^ Breathing & Heart Rates
• Shallow Breaths
• Low BP
• Limited Urine Production
• Inability to pass gas or
feces

10. Symptoms Con’t:
• An acutely ill patient tends to lie “very” still
because any movement causes excruciating pain.
• They will lie with there knees bent to decrease
strain on the tender peritoneum.

11. Exam & Evaluation
• Feel & press the abdomen to detect any
swelling & tenderness in the area as well as
signs of fluid has collected in the area.
• Listen to the bowel sounds & check for
difficulty breathing, low blood pressure &
signs of dehydration.

12. Evaluation con’t:
• The usual sounds made by the active intestine and
heard during examination with a stethoscope will be
absent, because the intestine usually stops
functioning.
• The abdom may be rigid and boardlike
• Accumulations of fluid will be notable in primary
due to ascites.

13. Exams con’t:
• Blood Test
• Samples of fluid from the abdomen
• CT Scan
• Chest X-rays
• Peritoneal lavage.

14. Treatment Approach
• Hospitalization is common.
• Surgery is often necessary to remove the source of
infection.
• Antibiotics are prescribed to control the infection
& intravenous therapy (IV) is used to restore
hydration.

15. TX Con’t:
• Morphine for pain.
• Dietary supplements (omega 3, omega 6
fatty acids, vitamin A, E, C, and zinc)

16. Prognosis
• Untreated peritonitis is poor, usually
resulting in death.
• With Tx, prognosis is variable, dependent
on the underlying causes.

17. Preventive Care
• There is “NO WAY” to prevent peritonitis,
since the diseases it accompanies are
usually not under the voluntary control of
an individual.
• However, the best way to prevent serious
complications is to seek medical attention
as soon as symptoms appear.

18. Histopathology of typical flask-shaped ulcer of intestine

19. This occurs in acute pancreatitis

20. References:
• “Evaluation and Management of Secondary
Peritonitis.” American Family Physician 54
(October 1996): 1724+.
• “Subacute Bacterial Peritonitis: Diagnosis and
Treatment.” American Family Physician 52
(August 1995): 645.
• Isselbacher, Kurt J., and Alan Epstein.
“Diverticular, Vascular, and Other Disorders of
the Intestinal and Peritoneum.” In Harrison’s
Principles of Internal Medicine, ed. Anthony S.
Fauci, et al. New York: McGraw-Hill, 1997.

21. References con’t:
• Platell C., Papadimitiriou J M., Hall J.C. The
Influence of Lavage Fluid on Peritonitis. Journal
of American College Surg 2000; 191: 672-680.
• Boeschoten, EW. Long-Term Consequences of
Peritonitis. Perit Dial Int. 1996;16(suppl 1):
S349-S354.