Peritonitis is the inflammation of peritoneum. Peritoneal cavity covers all viscera of abdomen. Peritoneal cavity is the largest cavity in the body. It is characterized by acute and chronic condition.
CAUSES OF PERITONITIS
Peritonitis is usually caused by
•Bacterial infection, gastrointestinal and non-gastrointestinal infection.
•chemical also leads to peritonitis like burn and barium solution.
•Due to any allergy example starch.
•Trauma during surgery example operative handling.
Localised Peritonitis
Patient usually complains of pain in affected area usually in localized area. If inflammation arises under diaphragm, patient feels shoulder tip pain .This pain referred to C5 dermatome. If peritonitis occurs in pelvic region example from an inflamed appendix or salpingitis, abdominal sign may be limited, deep tenderness may be detected by digital rectal or vaginal examination. Most commonly patient becomes tachycardiac and complaining of temperature (pyrexia). Vitals may be normal. The investigation of choice computed tomography (CT scan). If findings are inconclusive then proceed for diagnostic laparoscopy. Treatment is to remove the underlying cause and to lavage or dilute residual contamination. At surgery appearance of peritoneum is red, thick and velvety texture. Reactionary and serous exudate turbid in appearance. If not evacuated, it may transform to pus.
Diffuse Peritonitis
Diffuse peritonitis involved the regions of parietal peritoneum. It usually results from perforation of any viscus example obstructed colon, when large volume of blood enters into peritoneal cavity example ruptured aortic aneurysm or when substantial volume pour incessantly into the peritoneal cavity example perforated duodenal ulcer or anastomotic leak. In start pain is localized then become diffuse. Patient presents with deranged vitals mostly in advanced cases presents with hypotensive, tachycardiac and fever. Patient drowsy, confused and disoriented if underlying pathology not treated patient will lose consciousness. Investigation of choice Chest X-ray Errect it shows air under diaphragm. Patient should proceed for surgery to treat underlying cause.
Clinical Features Of Peritonitis
- Abdominal pain that becomes worse on movement
- Anorexia
- Malaise
- Nausea
- Vomiting
- Raised Pulse
- Pyrexia
On Examination
Tenderness +/- guarding, rigidity, rebound of abdominal wall, tenderness feels on rectal and vaginal examination (in case of pelvic peritonitis)
Management of Peritonitis
•Initially when patient presented in emergency department.
•Keep patient Nill per oral.
•Correction of fluids and electrolyte imbalance.
•Place Nasogastric tube
•Place Urine catheter
•Analgesia
•Strict vital monitoring
•Surgical treatment of cause when appropriate
•Source control by removal or exclusion of the cause
•Peritoneal lavage +/- drainage