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Peritonitis (Inflammation of the Peritoneum)

Wednesday, July 18th 2012. | Digestive System, Disease

 

Peritonitis Definition

Peritonitis is characterized by inflammation or acute infection of the peritoneum, sheath that surrounds all the viscera in the abdominal cavity.

Most often bacteria original, it is due to intestinal perforation or a spread of germs from an infected organ (eg stomach, intestines, gallbladder). The gastrointestinal perforation are the most common cause the cause of peritonitis.

The infection can be localized or spread throughout the body via the bloodstream. In the latter case, it is called sepsis.

In most cases, the treatment of peritonitis is surgical. The procedure used, the evolution of the disease and the chances of recovery depend largely on the underlying disease and the patient’s general condition.

Complications are more common in elderly and immunocompromised individuals.

Peritonitis Causes

There are two forms of peritonitis: peritonitis localized and generalized peritonitis, in which the infection spreads to the whole body through the bloodstream. This is known as sepsis. In the case of generalized peritonitis, it is a serious clinical picture that requires immediate therapeutic management.

Without proper treatment, peritonitis progresses rapidly to systemic infection called sepsis. For this reason, any localized peritonitis must be treated very quickly.

In the acute stage, the exact cause of peritonitis is often difficult to identify. We speak simply of “acute abdomen.”

Peritonitis (img : medicinabih.info)

Peritonitis Primary Causes

This is a rare form of peritonitis occurring mainly in children and immunocompromised individuals. Inflammation of the peritoneum follows the spread of germs from an infected organ in the pelvis; Dissemination the germs can also be done through blood.

Peritonitis Secondary Causes

This is the most common form. Inflammation of the peritoneum is usually due to perforation of a viscus contents into the abdominal cavity (eg, stomach, intestines, gallbladder, appendix), with discharge of its contents into the peritoneal cavity. Less often, peritonitis is due to trauma, intestinal obstruction, circulatory disorders in the intestines, strangulation of a hernia or dysfonctionnemt of surgical sutures.

Other causes of peritonitis:

  • Perforated ulcers
  • Perforations after surgery or trauma (car accidents, stabbings).
  • Tumors
  • Foreign body
  • Inflammatory bowel diseases: ulcerative colitis, Crohn’s disease
  • Salpingitis
  • Chemicals (eg contrast media for radiography) (rare)

Peritonitis Symptoms

  • Severe abdominal pain
  • Contraction rigid, permanent and painful muscles of the abdominal wall, the subject is to bend and to decrease pain intensity and tension of the contracture of the abdominal wall
  • Nausea, vomiting
  • No stool and gas
  • Agitated patient, pale, anxious
  • Signs of shock (medical emergency in the acute stage): rapid pulse, drop in blood pressure, cold sweats, fever, decreased urine volume (renal failure)

Peritonitis Diagnosis

It should move quickly to review because the patient is in critical condition:

  • History taking into account the patient’s symptoms: the mode of onset of symptoms and their evolution can provide valuable information to the physician.
  • Physical examination :
  • Palpation: Examination of the elasticity of the abdominal wall and location of pain.
  • Auscultation: bowel sounds are decreased or absent.
  • Digital rectal exam: subject index, the physician may palpate tumors, hemorrhages, or retention of feces.
  • Measurement of temperature, pulse and blood pressure, auscultation of heart and lung
  • Blood tests
  • Ultrasound (detection of liquid in the abdominal cavity)
  • Radiography of the abdomen
  • Under uncertainty: surgical opening of the abdomen

Peritonitis Treatment Options

Primary objective: elimination of the infectious focus. Treatment is mainly surgical and concerns the underlying disease (eg in case of appendicitis or perforated appendix, the single most important thing is to resect the appendix).

Since these bacterial infections, the use of antibiotics is necessary before surgery

The scope, duration and risks of the procedure depends on the cause of the illness or underlying peritonitis. The goal of intervention is to resect necrotic or damaged tissue, in some cases, part of the body (eg part of the intestine) must be removed. Often, it makes several interventions. In some cases, the abdominal wall is sutured temporarily to allow the pus to drain freely. After 48 hours, a second procedure is performed. At the end of surgery, a patient’s stay in the ICU is often necessary to optimize therapeutic management.

The abdominal cavity is cleaned with antiseptic solution, an antibiotic is often associated.

If removal of a significant portion of the intestines, often one proceeds to an artificial anus, which is then removed after a few weeks

Peritonitis Possible Complications

The duration of the period of reconvalescence depends largely on the underlying disease to peritonitis and the patient’s general condition.

Complications are more common in elderly subjects with chronic diseases than in healthy young subjects.

Peritonitis Apart from the shock, other complications can be observed :

  • Abscesses in the abdominal organs in the abdominal cavity or
  • Inflammatory reactions and adhesion formation in the intestine, therefore: intestinal obstruction of mechanical type (ileus)
  • Inflammation by toxic substances can also lead to disorders of intestinal motility; result: paralytic ileus
  • Any bowel obstruction can cause shock, recurrence of bowel obstruction in the four years following was observed in 50% of cases

Peritonitis Complications after surgery

  • During the operation, nerves or blood vessels may be injured. The type of response depends on the extent of peritonitis. An extension of the operation and the removal of an organ or reoperation (due to bleeding or leaking sutures) may sometimes be necessary
  • Fistulas may develop, requiring re operation.
  • Wound infection: in this case, open the suture permetter for the pus to drain.

Other complications are possible, such as nerve injuries, soft tissue, skin and other tissues. Moreover, adhesions can form in the abdominal cavity and cause pain. Thrombosis and embolism can also be observed.

 

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