Acute peritonitis

Acute peritonitis

Acute peritonitis

Def=inflammation of peritoneum is called peritonitis

CAUSES
A)PRIMARY PERITONITIS
1)spontaneous peritonitis of childhood
2)spontaneous peritonitis of adults
3)tuberculous peritonitis
4)peritonitis a/w dialysis

B)SECONDARY PERITONITIS
peritonitis due to intra abdominal
source



1)perforation of hollow viscus
*perforated duodenal ulcer,gastric ulcer
*perforated enteric ulcer,tubercular ulcer
*perforated Meckel's diverticulum
*perforated colonic ulcer

2)direct spread post inflammatory
*acute cholecystitis
*acute appendicitis
3)penetrating injuries to abdo.
4)post operative peritonitis=due to introduction of inf during surgery
*improper suerilization technique
*foreign body in abdo.
5)parturition peritonitis

PATHOGENESIS
1)Gram negative organisms=E coli,proteus,klebsiella
2)enterococci=streptococci faecalis.Present in urinary tract,genital tract,intestine.
3)bacteroids=anaerobic organisms,present mainly in lower intestine
4)bacteria from outside alimentary tract=gonococci,pneumococci,tubercular orgamism
5)these organisms proliferate in perotoneal cavity resulting in peritonitis
6)this result in large amt of fluid secretion in peritoneal cavity which leads to hypovolaemic shock
7)fluid is rich in fibrinogen which form fibrin n localises inf.
8)peritoneum becomes reddish n oedematous covered with thick fibrous exudate.

C/F =
1)severe abd pain=cutting in nature,become worse on movement of abd wall
2)persistant vomiting due to irritation of parietal peritoneum
3)pulse rate incrsd
4)high grade fever with chills n rigor
5)cough tenderness indicates parietal peritoneum inflammation
6)rebound tenderness/Blumbergs sign=abd is pressed 4 few sec.Pt experiences pain.Sudden release of press causes severe pain due to sudden movement of sensitive parietal peritoneum
7)guarding n rigidity
8)bowel sounds r absent
9)end stage disease=Hippocratic facies

INVESTIGATION
1)complete bld pict shows high total count with predominant neutrophils
2)urine n bld 4 sugar
3)plain X ray abd erect
*gas under diaphragm=perforation
*ground glass appearance due to fluid
*obliteration of psoas shadow
4)abd usg to detect fluid in abd
5)4 quadrant abdominal tap
*aspiration of bld indicates haemoperitoneum n gangrene of bowel
*aspiration of bile=biliary peritonitis
*aspiration of frank pus=peritonitis due to gm -ve bacteria
*amylase estimation should b done to rule out pancreatitis
6)diagnostic laparoscopy
*used to confirm peritonitis
*can diagnose pancreatitis
*peritoneal toilet can b done

MANAGEMENT
1)Aspiration=nasogastric aspiration decreases git secretion thus reduces abd distension.Prevent vomiting n give rest to guj
2)bowel care n bld=purgatives should not b given
3)charts=temp,pulse rate,rr
4)drugs=against gm +ve,-ve n anaerobes
5)exploratory laparotomy
6)iv fluids before,during n after surgery

COMPLICATIONS OF PERITONITIS
1)severe hypovolemic shock
2)septic shock,multi organ failure
3)subacue intestinal obstruction
4)pelvic abscess
5)subphrenic abscess 

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