Defintion
- inflammation of the peritoneal cavity
Causes
- infectious
- auto immune
- neoplastic
- chemical
Types
- primary
- source is infection is outside abdomen
- seeds through peritoneal cavity/hematogenous/ lymphagenous
- Secondary
- source if abdominal cavity itself
- extension from or rupture of abdominla viscus or organ abscess
Acute primary peritononitis
- bacterial infection without intra abdominal source
- results from translocation of gut bacteria or immune dysfunction
- monomicrobial
causes
- MC - pneumococci
- enterococci
- GABHS
- staph
- gram neg
- Mycobacterium
- neisseria
Clinical features
- fever
- abdominal pain
- nausea and vomiting
- diarrhoea
Examination
- rigidity
- rebound tenderness
- hypotension
- tachycardia
- bowel sounds - absent or less
- shallow respiration
Diagnosis
- CBC
- USG, xray, CT abdomen
- paracentesis - >250 cells/cu.mm, >50% PMN
Treatment
- antibiotic accordingly
- cefotaxime or vancomycin
Acute Secondary Peritonitis
- infection from intra-abdominal source
- poly microbial
Causes
- perforation, rupture, obstruction
- MC - appendix perforation
- other causes - merkels, incarcirated hernia, midgut volvulus, peptic perforation
- in neonatal - MC NEC
- post pubertal girls - from fallopian tubes
Clinical features
- Similar to above
- Toxic looking
Diagnosis
- CBC WBC > 12000
- Xray - free air in peritoneal cavity, ileus, obstruction
- peritoneal fluid - low glucose <50 mg/dl, total protein > 1g/dl
Treatment
- Ampicillin + gentamycin + clindamycin
- cipro + metro
- piptaz /carbapenum
- surgery for perforation
Acute secondary localised peritonitis
Sites
- hepatic
- splenic
- renal
- pancreatitis
- tubo-ovarian
Clinical features
- prolonged fever
- vomiting
- lassititude
- Appendiceal abscess - localised tenderness in McBurney point
- pelvic absess - pain during defecation
- psoas abcess - limp,hip pain and fever
diagnosis
Treatment
- abscess drinage
- indwelling catheter
- surgical exploration of abscess
- duration is 4-6 weeks