Peritonitis causes: Difference between revisions
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===Infected peritonitis=== | ===Infected peritonitis=== | ||
* Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal[[ | * 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 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]]''). | ||
* 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]], 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]]. | * 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]], 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]]. | ||
* 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. | * 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. | ||
Revision as of 18:00, 3 April 2013
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Peritonitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Causes
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 distalesophagus (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 trauma, ingestion of 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 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).
- 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 trauma, surgical wound, continuous ambulatory peritoneal dialysis, 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.
- 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.
Non-infected peritonitis
- Leakage of sterile body fluids into the peritoneum, such as blood (e.g.endometriosis, blunt abdominal trauma), gastric juice (e.g. peptic ulcer, gastric carcinoma),bile (e.g. liver biopsy), urine (pelvic 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 adhesions. Obviously, peritonitis may also be caused by the rare, unfortunate case of a 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.