Acute Peritonitis Causes Symptoms Diagnosis Treatment

Peritonitis

Peritonitis is inflammation of peritoneum. Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intraabdominal surgically-treatable source

ACUTE PERITONITIS

• Peritonitis is inflammation of peritoneum.
• May be localized or diffuse, acute or chronic, infec­tious or aseptic.
• Acute peritonitis is usually infectious and related with perforation.
• There is decreased motility of intestines, with gas and fluid in lumen.
• There is intravascular volume depletion.

Causes of peritonitis are

• · Perforation of viscus
• · Foreign body
• · Peritoneal dialysis
• · Hernia
• · Gangrene
• · Volvulus
• · Bowel infarction
• · Cancer
• · Intestinal obstruction
• · Inflammatory bowel disease.

Clinical features Symptoms

• · Acute abdominal pain
• · Fever
• · Tenderness
• · Rigidity
• · Absent bowel sounds
• · Tachycardia
• · Hypotension
• · Dehydration
• · Acidosis
• · Leucocytosis
• · Edema of bowel wall
• Ascites prevents the development of a rigid abdomen by separating the visceral from the parietal peritoneal surfaces
• · Ascites
• · Free air under diaphragm seen with X-ray, CT, USG (Ultra sonography).
• The signs and symptoms of both SBP and surgical peritonitis in the presence of ascites can be surprisingly subtle

Risk factors —

• The vast majority of patients with SBP have advanced cirrhosis
• . Other risk factors (most of which are associated with cirrhosis) include
• Ascitic fluid total protein concentration less than 1 g/dL (<10 g/L)
• Prior episode of SBP Serum total bilirubin concentration above 2.5 mg/dL
• Variceal hemorrhage Possibly malnutrition
• Possibly use of proton pump inhibitors

Acute Peritonitis Diagnosis –

• diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 250 cells/mm3)
• The prevalence of bacterial overgrowth was higher in the patients with a history of SBP (70 versus 20 percent); these patients also exhibited more severe small intestinal motility disturbances.
• bacterial translocation is increased in patients with advanced cirrhosis
• Total protein concentration >1 g/dL (10 g/L)
• Glucose concentration <50 mg/dL (2.8 mmol/L)
• Lactate dehydrogenase greater than the upper limit of normal for serum

Acute Peritonitis Treatment

• Correct hydration, electrolytes Surgical correction
• Antibiotics
• Management of complications.