Peritonitis

Definition
  • Peritonitis: Inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.
Etiology
  • Most commonly due to a bacterial infection often secondary to abdominal trauma, surgeries, or a ruptured organ.
  • Other causes: chemical irritants (e.g., bile, gastric acid), blood, fungi, or viruses.
  • Types:
    • Primary: Often due to cirrhosis or ascites, not caused by any identifiable intra-abdominal source.
    • Secondary: Resulting from a pathological condition within the abdomen like appendicitis or diverticulitis.
    • Tertiary: Persistent infection after treatment of primary or secondary peritonitis.
Clinical Presentation
  • Severe abdominal pain that is worsened with movement.
  • Abdominal tenderness and rigidity (“board-like abdomen”).
  • Fever and chills.
  • Nausea and vomiting.
  • Anorexia.
  • Possible altered bowel habits.
Investigations
  • Abdominal X-ray: May show gas patterns suggestive of ileus or free air if there’s a perforation.
  • Abdominal CT scan: Useful to determine the cause, especially in secondary peritonitis.
  • Paracentesis: Aspirating fluid from the abdomen for examination, cultures, and cell counts.
  • Complete blood count: May show elevated white blood cells.
  • Blood cultures: To identify any causative bacteria.
Management
  • Immediate hospitalisation.
  • Administer broad-spectrum intravenous antibiotics ā€“ later tailored based on culture results.
  • Surgery to treat the root cause, e.g., repair of a ruptured organ.
  • Fluid resuscitation and possible nutritional support.
  • Analgesics for pain.
Complications
  • Septic shock: Life-threatening decrease in blood pressure due to sepsis.
  • Abscess formation in the abdomen.
  • Organ failure.
  • Adhesions leading to bowel obstruction in the long term.

Early recognition and intervention in peritonitis are crucial given its potential severity and life-threatening complications.

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