This document discusses peritonitis, which is inflammation of the peritoneum. It defines peritonitis and outlines its classification as either acute or chronic. Acute peritonitis can be primary (spontaneous) or secondary. Secondary acute peritonitis has several subtypes including suppurative, granulomatous, chemical, interventional, traumatic, and drug induced. Chronic peritonitis can be infectious, drug induced, chemical, due to foreign bodies, or carcinomatous. The document also covers the pathogenesis, signs and symptoms, investigations, and management of peritonitis.

1. PERITONITIS
PRESENTER: DR M B PHIRI
MODERATOR: DR MUKUNYANDELA

2. OUTLINE
• Definition
• Anatomy
• Classification
• Pathogenesis
• Signs and symptoms
• Investigation
• Management

3. DEFINATION
• Inflamation of the peritoneum (serosa)

4. ANATOMY
• Peritonuem is a serous membrane that has 2 layers parietal and visceral
• Potential space between the 2 layers
• Normally peritoneal fluid is less than 50ml (ultrafiltrate)

5. CLASSIFICATION
• ACUTE PERITONITIS
• Primary (spontaneous)
• Secondary – acute suppurative, granulomatous, chemical (aseptic), interventional,
traumatic, drug induced
• CHRONIC PERITONITIS
• Infectious, drug induced, chemical, foreign body, carcinomatous

6. PRIMARY PERITONITIS
• Also called spontaneous peritonitis
• No obvious identifiable cause
• Common in girls and young women, infection presumed through fallopian tube
• Also common in adults with ascites as SBP and patients with indwelling catheter
for peritoneal dialysis

7. SECONDARY PERITONITIS
• Acute suppurative
• Secondary to any bowel or other visceral pathology eg perforation of a viscus or
extension of existing infection of an abdominal organ eg appendicular abscess,
liver abscess
• Chemical (aseptic) peritonitis
• Peritoneal inflammation from other substances other than bacteria
• Perforated peptic ulcer provides chemical peritonitis and acute pancreatitis

8. PATHOGENESIS
• Initially localized, affected area contained by omentum
• Localized peritonitis may progress
• Exudation of inflammatory fluid into peritoneal cavity
• Diffuse peritoneal irritation causes peristaltic paralysis

9. CLINICAL MANIFESTATION
• Malaise, nausea, vomiting, low grade fever, abdominal pain
• Examination – tenderness, guarding or rigidity, distension, free peritoneal air,
diminished bowel sounds
• Systemic findings – fever, chills, tarchycardia, restlessness, signs of shock
• APACHE II (Acute Physiology And Chronic Health Evaluation) uses 12
physiological variables and Mannheim peritonitis index uses 8 parameters

10. INVESTIGATIONS
• FBC, ABGs, electrolytes, LFT, RFT
• Radiology – abdominal xray, abd U/S
• Paracentesis
• Laparascopy

11. MANAGEMENT
• Principles
• To control source of infection
• To eliminate micro organisms
• To maintain vital organ function
• Nutrition and metabolic support
• Mordalities of therapy
• Fluid rescussitation
• Systemic antibiotics
• Surgical drainage

12. REFERENCES
• Bailey and love
• SRB manual