Peritonitis overview: Difference between revisions
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{{Peritonitis}} | {{Peritonitis}} | ||
{{CMG}} | {{CMG}} {{AE}} | ||
==Overview== | ==Overview== | ||
'''Peritonitis''' is defined as [[inflammation]] of the [[peritoneum]] (the [[serous membrane]] which lines part of the [[abdomen|abdominal cavity]] and some of the [[viscera]] it contains). It may be localised or generalised, generally has an acute course, and may depend on either [[infection]] (often due to rupture of a hollow [[viscus]]) or on a non-infectious process. Peritonitis generally represents a [[surgical emergency]]. | '''Peritonitis''' is defined as [[inflammation]] of the [[peritoneum]] (the [[serous membrane]] which lines part of the [[abdomen|abdominal cavity]] and some of the [[viscera]] it contains). It may be localised or generalised, generally has an acute course, and may depend on either [[infection]] (often due to rupture of a hollow [[viscus]]) or on a non-infectious process. Peritonitis generally represents a [[surgical emergency]]. | ||
==Historical Perspective== | |||
==Classification== | |||
==Pathophysiology== | ==Pathophysiology== | ||
The [[peritoneum]] normally appears greyish and glistening; it becomes dull 2-4 hours after the onset of peritonitis, initially with scarce, [[serous]], or slightly [[turbid]] fluid. Later on, the [[exudate]] becomes creamy and evidently [[suppurative]]; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated [[exudate]] varies widely. It may be spread to the whole [[peritoneum]], or be walled off by the [[omentum]] and [[viscera]]. [[Inflammation]] features infiltration by [[neutrophils]] with fibrino-purulent exudation. | The [[peritoneum]] normally appears greyish and glistening; it becomes dull 2-4 hours after the onset of peritonitis, initially with scarce, [[serous]], or slightly [[turbid]] fluid. Later on, the [[exudate]] becomes creamy and evidently [[suppurative]]; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated [[exudate]] varies widely. It may be spread to the whole [[peritoneum]], or be walled off by the [[omentum]] and [[viscera]]. [[Inflammation]] features infiltration by [[neutrophils]] with fibrino-purulent exudation. | ||
==Causes== | |||
==Differentiating Peritonitis from Other Diseases== | |||
==Epidemiology and Demographics== | |||
==Risk Factors== | ==Risk Factors== | ||
Patients with liver disease are at increased risk. Risk factors for liver disease include alcoholic [[cirrhosis]] and other diseases that lead to [[cirrhosis]], such as [[viral hepatitis]] ([[Hepatitis B]] or C). Spontaneous peritonitis also occurs in patients who are on [[dialysis]] for [[kidney failure]]. | Patients with liver disease are at increased risk. Risk factors for liver disease include alcoholic [[cirrhosis]] and other diseases that lead to [[cirrhosis]], such as [[viral hepatitis]] ([[Hepatitis B]] or C). Spontaneous peritonitis also occurs in patients who are on [[dialysis]] for [[kidney failure]]. | ||
==Screening== | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | |||
===Complications=== | |||
===Prognosis=== | |||
With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment. | With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment. | ||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Criteria=== | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The main manifestations of peritonitis are acute abdominal [[abdominal pain|pain]], [[abdominal tenderness|tenderness]], and [[abdominal guarding|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). | The main manifestations of peritonitis are acute abdominal [[abdominal pain|pain]], [[abdominal tenderness|tenderness]], and [[abdominal guarding|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). | ||
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]]. | 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]]. | ||
===Physical Examination=== | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
A [[diagnosis]] of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay [[surgery]]. [[Leukocytosis]] and [[acidosis]] may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, oedematous intestines, although it is mainly useful to look for [[pneumoperitoneum]] (free air in the peritoneal cavity), which may also be visible on [[chest X-rays]]. If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e.g. in cause of [[physical trauma|trauma]], in order to look for [[white blood cells]], [[red blood cells]], or [[bacteria]]). | A [[diagnosis]] of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay [[surgery]]. [[Leukocytosis]] and [[acidosis]] may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, oedematous intestines, although it is mainly useful to look for [[pneumoperitoneum]] (free air in the peritoneal cavity), which may also be visible on [[chest X-rays]]. If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e.g. in cause of [[physical trauma|trauma]], in order to look for [[white blood cells]], [[red blood cells]], or [[bacteria]]). | ||
===Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | |||
===Surgery=== | ===Surgery=== | ||
[[Surgery]] ([[laparotomy]]) is needed to perform a full exploration and lavage of the [[peritoneum]], as well as to correct any gross anatomical damage which may have caused peritonitis.<ref name="titlePeritonitis: Emergencies: Merck Manual Home Edition">{{cite web |url=http://www.merck.com/mmhe/sec09/ch132/ch132g.html |title=Peritonitis: Emergencies: Merck Manual Home Edition |accessdate=2007-11-25 |format= |work=}}</ref> The exception is [[spontaneous bacterial peritonitis]], which does not benefit from [[surgery]]. | [[Surgery]] ([[laparotomy]]) is needed to perform a full exploration and lavage of the [[peritoneum]], as well as to correct any gross anatomical damage which may have caused peritonitis.<ref name="titlePeritonitis: Emergencies: Merck Manual Home Edition">{{cite web |url=http://www.merck.com/mmhe/sec09/ch132/ch132g.html |title=Peritonitis: Emergencies: Merck Manual Home Edition |accessdate=2007-11-25 |format= |work=}}</ref> The exception is [[spontaneous bacterial peritonitis]], which does not benefit from [[surgery]]. | ||
===Prevention=== | |||
==References== | ==References== | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Revision as of 19:04, 6 July 2016
|
Peritonitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Peritonitis is defined as inflammation of the peritoneum (the serous membrane which lines part of the abdominal cavity and some of the viscera it contains). It may be localised or generalised, generally has an acute course, and may depend on either infection (often due to rupture of a hollow viscus) or on a non-infectious process. Peritonitis generally represents a surgical emergency.
Historical Perspective
Classification
Pathophysiology
The peritoneum normally appears greyish and glistening; it becomes dull 2-4 hours after the onset of peritonitis, initially with scarce, serous, or slightly turbid fluid. Later on, the exudate becomes creamy and evidently suppurative; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated exudate varies widely. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera. Inflammation features infiltration by neutrophils with fibrino-purulent exudation.
Causes
Differentiating Peritonitis from Other Diseases
Epidemiology and Demographics
Risk Factors
Patients with liver disease are at increased risk. Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis (Hepatitis B or C). Spontaneous peritonitis also occurs in patients who are on dialysis for kidney failure.
Screening
Natural History, Complications and Prognosis
Natural History
Complications
Prognosis
With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment.
Diagnosis
Diagnostic Criteria
History and Symptoms
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).
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.
Physical Examination
Laboratory Findings
A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay surgery. Leukocytosis and acidosis may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, oedematous intestines, although it is mainly useful to look for pneumoperitoneum (free air in the peritoneal cavity), which may also be visible on chest X-rays. If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e.g. in cause of trauma, in order to look for white blood cells, red blood cells, or bacteria).
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Surgery (laparotomy) is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage which may have caused peritonitis.[1] The exception is spontaneous bacterial peritonitis, which does not benefit from surgery.
Prevention
References
- ↑ "Peritonitis: Emergencies: Merck Manual Home Edition". Retrieved 2007-11-25.