Peritonitis history and symptoms
|
Peritonitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
The clinical picture of peritonitis is determined by the nature of causative lesion, duration and extension of the inflammatory process, and stage of the disease. The main manifestations of peritonitis are acute abdominal pain, tenderness, and guarding, which are exacerbated by moving the peritoneum, e.g. coughing, flexing the hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits pain, but releasing the hand abruptly will aggravate the pain, as the peritoneum snaps back into place). It is important to emphasize, though, that hepatic encephalopathy may be the only manifestation of SBP, especially in people with cirrhosis and ascites.
Abdominal pain and tenderness: The localization of these manifestations depends on whether peritonitis is localized (e.g. appendicitis or diverticulitis before perforation), or generalized to the whole abdomen; even in the latter case, pain typically starts at the site of the causing disease. Peritonitis is an example of acute abdomen.
History
A directed history should be obtained to ascertain the precipitant of this condition. A detailed history has to be obtained regarding
- Previous episodes
- Associated conditions as diarrhea or other infections
- History related to liver disease, renal disease and heart disease
- Onset of symptoms and their progression
Common Symptoms of SBP
- Gradually increasing abdominal pain, initially localized to the region of the source of peritonitis and then extends all over the abdomen is the hallmark of peritonitis, although some patients may be asymptomatic.
- Some elderly patients may present with malaise, anorexia, weakness without any significant abdominal pain.
- Altered mental status may manifest as frank delirium, confusion, or cognitive slowing.
- Nausea/vomiting accompanied by hiccup
- Diarrhea
- Fever
- Worsening of pre-existing ascites and progressive encephalopathy in a patient with cirrhotic ascites
- Development of ileus paralyticus (i.e. intestinal paralysis), which also causes nausea and vomiting
Less common symptoms of SBP
- Bloating
- Anorexia
- Obstipation
- Low urine output
- Thirst
- Fatigue
- Chills
- Dizziness or weakness
- Breathlessness may be due to infection, fluid overload or underlying [[heart condition]