Peritonitis causes: Difference between revisions

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{{Peritonitis}}
{{Peritonitis}}
{{CMG}} {{AE}}
{{CMG}}; {{AE}} {{VSKP}} {{SCh}}


==Overview==
==Overview==
The most common cause of peritonitis is perforation of a hollow viscus such as perforation of the [[distal esophagus]] ([[Boerhaave syndrome]]), of the stomach ([[peptic ulcer]], [[gastric carcinoma]]), of the duodenum (peptic ulcer), of the remaining [[intestine]] (e.g. [[appendicitis]], [[diverticulitis]], [[Meckel's diverticulum]], [[IBD]], [[intestinal infarction]], intestinal strangulation, [[colorectal carcinoma]], [[meconium peritonitis]]), or of the gallbladder ([[cholecystitis]]).  Other causes of infected peritonitis include [[spontaneous bacterial peritonitis]] and disruption of the peritoneum, such as in cases of  trauma, surgical wounds, continuous [[peritoneal dialysis]], and [[intra-peritoneal]] [[chemotherapy]].  Causes of non-infected peritonitis include [[endometriosis]], blunt abdominal trauma, [[gastric carcinoma]], peptic ulcer, pelvic trauma, and [[pancreatitis]].
The most common cause of peritonitis is perforation of a hollow viscus such as perforation of the [[distal esophagus]] ([[Boerhaave syndrome]]), of the [[stomach]] ([[peptic ulcer]], [[gastric carcinoma]]), of the [[duodenum]] (peptic ulcer), of the remaining [[intestine]] (e.g. [[appendicitis]], [[diverticulitis]], [[Meckel's diverticulum]], [[IBD]], [[intestinal infarction]], [[intestinal strangulation]], [[colorectal carcinoma]], [[meconium peritonitis]]), or of the [[gallbladder]] ([[cholecystitis]]).  Other causes of infected peritonitis include [[spontaneous bacterial peritonitis]] and disruption of the peritoneum, such as in cases of  trauma, surgical wounds, continuous [[peritoneal dialysis]], and [[intra-peritoneal]] [[chemotherapy]].  Causes of non-infected peritonitis include [[endometriosis]], [[abdominal trauma|blunt abdominal trauma]], [[gastric carcinoma]], [[peptic ulcer]], [[pelvic trauma]], and [[pancreatitis]].


==Causes==
==Causes==
Causes of peritonitis can be divided into infected and non-infected, which are as follows:
Causes of peritonitis can be divided into infected and non-infected, which are as follows:
===Infected peritonitis===


* Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal [[esophagus]] ([[Boerhaave syndrome]]), of the [[stomach]] ([[peptic ulcer]], [[gastric carcinoma]], of the [[duodenum]] ([[peptic ulcer]]), of the remaining [[intestine]] (e.g. [[appendicitis]], [[diverticulitis]], [[Meckel diverticulum]], [[IBD]], intestinal infarction, intestinal strangulation, [[colorectal carcinoma]], [[meconium peritonitis]]), or of the [[gallbladder]] ([[cholecystitis]]). Other possible reasons for perforation include [[physical trauma|trauma]], ingestion of a sharp [[foreign body]] (such as a fish bone), perforation by an [[endoscope]] or [[catheter]], and anastomotic leakage. The latter occurrence is particularly difficult to diagnose early, as [[abdominal pain]] and [[ileus|ileus paralyticus]] are considered normal in patients who just underwent [[abdominal surgery]]. In most cases of perforation of a hollow viscus, mixed [[bacteria]] are isolated; the most common agents include [[gram-negative]] [[bacilli]] (e.g. ''[[Escherichia coli]]'') and [[anaerobic bacteria]] (e.g. ''[[Bacteroides fragilis]]'').
===Causes of Infected Peritonitis===
* Disruption of the [[peritoneum]], even in the absence of perforation of a hollow viscus, may also cause infection simply by letting [[micro-organisms]] into the peritoneal cavity. Examples include [[physical trauma|trauma]], surgical wound, continuous ambulatory [[peritoneal dialysis]], and intra-peritoneal [[chemotherapy]]. Again, in most cases mixed [[bacteria]] are isolated; the most common agents include cutaneous species such as ''[[Staphylococcus aureus]]'', and [[coagulase]]-negative [[staphylococci]], but many others are possible, including [[fungi]] such as [[Candida]].
{| class="wikitable"
* Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs either in [[children]], or in patients with [[ascites]]. See the article on [[spontaneous bacterial peritonitis]] for more information.
|-
* Systemic infections (such as [[tuberculosis]]) may rarely have a peritoneal localization.
! style="width: 50%;" | Perforation of a hollow viscus organ
! style="width: 20%;" |Disruption of the peritoneum
! style="width: 15%;" | Spontaneous bacterial peritonitis (SBP)
! style="width: 15%;" | Systemic infections
|-
| valign = top | '''''Perforation of a hollow viscus''''' (most common cause of peritonitis)
*Perforation of the [[Esophagus|distal esophagus]] ([[Boerhaave syndrome]])<br />
*Perforation of the [[stomach]] ([[peptic ulcer]], [[Gastric carcinoma]])<br />
*Perforation of the [[duodenum]] ([[peptic ulcer]])<br />
*Perforations of the remaining [[intestine]] (e.g. [[Appendicitis]], [[Diverticulitis]], [[Meckel diverticulum]], [[IBD]], [[Intestinal infarction]], [[Intestinal strangulation]], [[Colorectal carcinoma]], [[Meconium peritonitis]])<br />
*Perforation of the [[gallbladder]] ([[cholecystitis]])<br />
 
'''Other possible causes for perforation'''
 
*[[Trauma]] <br />
*Ingestion of a sharp [[foreign body]] (such as a fish bone) <br />
*Perforation by an [[endoscope]] or [[catheter]]
 
''' Most common organisms'''
-mixed [[bacteria]]
 
*[[Gram-negative bacilli]] (e.g. [[Escherichia coli]]), [[Anaerobic bacteria]] (e.g. [[Bacteroides fragilis]])
| valign = top |
*[[Trauma]]<br />
*[[Surgical wound]]<br />
*[[Peritoneal dialysis]]<br />
*[[Chemotherapy]]<br />
 
''' Most common organisms'''
 
*Mixed [[bacteria]] <br />
*[[Staphylococcus aureus]] <br />
*[[Coagulase-negative staphylococci]] <br />
*[[Fungi]] such as [[Candida]]
 
| valign = top |
Peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with [[ascites]].
 
| valign = top |
e.g.  [[Tuberculosis]]
|}
 
===Causes of Non-Infected Peritonitis===
 
{| class="wikitable"
|-
! style = "width: 50%;" | Leakage of sterile body fluids into the peritoneum
! style = "width: 25%;" |  Sterile abdominal surgery
! style = "width: 25%;" |  Rarer non-infectious causes
|-
| valign = top | '''''Sterile body fluids''''' such as
*[[Blood]](e.g.[[Endometriosis]], Blunt abdominal trauma),
*[[Gastric juice]] (e.g.[[Peptic ulcer]], [[Gastric carcinoma]]),
*[[Bile]] (e.g. [[Liver biopsy]]),
*[[Urine]] (e.g. [[Pelvic trauma]]),
*[[Menstruum]] (e.g. [[salpingitis]]),
*[[Pancreatic juice]] ([[pancreatitis]]),
These body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.


===Non-infected peritonitis===
| valign = top |
Due to [[sterile]] [[foreign body]] inadvertently left in the abdomen after surgery (e.g. [[gauze]], [[sponge]])
 
| valign = top |
* [[Familial Mediterranean fever]]
* [[Porphyria]]
* [[Systemic lupus erythematosus]]
 
|}


* Leakage of [[sterilization (microbiology)|sterile]] [[body fluids]] into the peritoneum, such as [[blood]] (e.g.[[endometriosis]], blunt abdominal [[physical trauma|trauma]]), [[gastric juice]] (e.g. [[peptic ulcer]], [[gastric carcinoma]]),[[bile]] (e.g. [[liver biopsy]]), [[urine]] (pelvic [[physical trauma|trauma]]), [[menstruum]] (e.g. [[salpingitis]]), [[pancreatic juice]] ([[pancreatitis]]), or even the contents of a ruptured [[dermoid cyst]]. It is important to note that, while these [[body fluids]] are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.
* Sterile abdominal surgery normally causes localized or minimal generalized peritonitis, which may leave behind a foreign body reaction and/or fibrotic [[adhesion (medicine)|adhesion]]s. Obviously, peritonitis may also be caused by the rare, unfortunate case of a [[sterile technique|sterile]] [[foreign body]] inadvertently left in the [[abdomen]] after [[surgery]] (e.g. [[gauze]],[[sponge]]).
* Much rarer non-infectious causes may include [[familial Mediterranean fever]], [[porphyria]], and [[systemic lupus erythematosus]].
===Causes by Organ System===
===Causes by Organ System===


{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|  [[Continuous ambulatory peritoneal dialysis]], [[Intra-peritoneal chemotherapy]], [[Surgical wounds]   
|bgcolor="Beige"|  [[Continuous ambulatory peritoneal dialysis]], [[Intra-peritoneal chemotherapy]], [[Surgical wounds]]   
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|  [[Bacteroides fragilis]], [[E. coli]], [[Enterobacteriaceae]], [[Escherichia coli]], [[Fitz-hugh curtis syndrome]], [[Klebsiella pneumoniae]], [[Pseudomonas]], [[Staphylococcus]], [[Streptococcus pneumoniae]], [[Streptococcus pyogenes]]  
|bgcolor="Beige"|  [[Bacteroides fragilis]], [[E. coli]], [[Enterobacteriaceae]], [[Escherichia coli]], [[Fitz-Hugh Curtis syndrome]], [[Klebsiella pneumoniae]], [[Pseudomonas]], [[Staphylococcus]], [[Streptococcus pneumoniae]], [[Streptococcus pyogenes]], [[Miliary tuberculosis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Endometriosis]], [[Fitz-hugh curtis syndrome]], [[Pelvic inflammatory disease]]  
|bgcolor="Beige"| [[Endometriosis]], [[Fitz-Hugh Curtis syndrome]], [[Pelvic inflammatory disease]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Systemic lupus erythematosus]],
|bgcolor="Beige"| [[Systemic lupus erythematosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-
|-
|}
|}
===Causes in Alphabetical Order===
{{columns-list|
*[[Appendicitis]]
*[[Ascites]]
*[[Bacteroides fragilis]]
*[[Boerhaave syndrome]]
*[[Cholecystitis]]
*[[Cholelithiasis]]
*[[Chronic liver disease]]
*[[Colorectal carcinoma]]
*[[Peritoneal dialysis|Continuous ambulatory peritoneal dialysis]]
*[[Diverticulitis]]
*[[Endometriosis]]
*[[Enterobacteriaceae]]
*[[Escherichia coli]]
*[[Fitz-Hugh Curtis syndrome]]
*[[Gall stone disease|Gall bladder rupture]]
*[[Gastrointestinal perforation]]
*[[IBD]]
*[[Intestinal strangulation]]
*[[Chemotherapy|Intra-peritoneal chemotherapy]]
*[[Klebsiella pneumoniae]]
*[[Mallory-Weiss syndrome]]
*[[Meckel diverticulitis]]
*[[Meconium peritonitis]]
*[[Muckle-Wells syndrome]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nephritic syndrome]]
*[[Pancreatitis]]
*[[Pelvic inflammatory disease]]
*[[Peptic ulcer]]
*[[Perihepatitis]]
*[[Peritoneal dialysis]]
*[[Pseudomonas]]
*[[Recurrent hereditary polyserositis]]
*[[Ruptured dermoid cyst]]
*[[Spontaneous bacterial peritonitis]]
*[[Staphylococcus]]
*[[Streptococcus milleri]]
*[[Streptococcus pneumoniae]]
*[[Streptococcus pyogenes]]
*[[Surgical wounds]]
*[[Systemic lupus erythematosus]]
*[[Toxic megacolon]]
*[[Trauma]]
*[[Typhlitis]]
*[[Tuberculosis]]
}}


==References==
==References==
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[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
 


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Latest revision as of 22:24, 10 January 2020

Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2] Shivani Chaparala M.B.B.S [3]

Overview

The most common cause of peritonitis is perforation of a hollow viscus such as perforation of the distal esophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma), of the duodenum (peptic ulcer), of the remaining intestine (e.g. appendicitis, diverticulitis, Meckel's diverticulum, IBD, intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Other causes of infected peritonitis include spontaneous bacterial peritonitis and disruption of the peritoneum, such as in cases of trauma, surgical wounds, continuous peritoneal dialysis, and intra-peritoneal chemotherapy. Causes of non-infected peritonitis include endometriosis, blunt abdominal trauma, gastric carcinoma, peptic ulcer, pelvic trauma, and pancreatitis.

Causes

Causes of peritonitis can be divided into infected and non-infected, which are as follows:

Causes of Infected Peritonitis

Perforation of a hollow viscus organ Disruption of the peritoneum Spontaneous bacterial peritonitis (SBP) Systemic infections
Perforation of a hollow viscus (most common cause of peritonitis)

Other possible causes for perforation

Most common organisms -mixed bacteria

Most common organisms

Peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with ascites.

e.g. Tuberculosis

Causes of Non-Infected Peritonitis

Leakage of sterile body fluids into the peritoneum Sterile abdominal surgery Rarer non-infectious causes
Sterile body fluids such as

These body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.

Due to sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge)

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Appendicitis, Ascites, Boerhaave syndrome, Cholecystitis, Cholelithiasis, Chronic liver disease, Diverticulitis, Gall bladder rupture, Gastrointestinal perforation, IBD, Intestinal strangulation, Mallory-Weiss syndrome, Meckel diverticulitis, Meconium peritonitis, Neonatal necrotizing enterocolitis, Pancreatitis, Peptic ulcer, Perihepatitis, Recurrent hereditary polyserositis, Toxic megacolon, Typhlitis
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Continuous ambulatory peritoneal dialysis, Intra-peritoneal chemotherapy, Surgical wounds
Infectious Disease Bacteroides fragilis, E. coli, Enterobacteriaceae, Escherichia coli, Fitz-Hugh Curtis syndrome, Klebsiella pneumoniae, Pseudomonas, Staphylococcus, Streptococcus pneumoniae, Streptococcus pyogenes, Miliary tuberculosis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic Endometriosis, Fitz-Hugh Curtis syndrome, Pelvic inflammatory disease
Oncologic Colorectal carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Nephritic syndrome
Rheumatology/Immunology/Allergy Systemic lupus erythematosus
Sexual No underlying causes
Trauma Trauma
Urologic No underlying causes
Miscellaneous Ruptured dermoid cyst, Spontaneous bacterial peritonitis

Causes in Alphabetical Order

References


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