PREITONITIS:

CAUSES, SYMPTOMS,
AND TREATMENT
OPTIONS

Dina Hassan
 UNDERSTANDING
PERITONITIS

An in-depth look at the

causes, symptoms, and
treatment options for
peritonitis. This
presentation aims to
provide a comprehensive
understanding of this
serious condition.
WHAT IS PERITONITIS?

Inflammation of the
peritoneum, which is the inner
membrane that lines the
abdominal cavity and
abdominal organs.
Peritonitis is typically caused
by an infection involving
gastrointestinal or pelvic
organs, and it can be life
threatening if left untreated.
CAUSES OF PERITONITIS

Infection may spontaneously begin in the peritoneum (known as spontaneous

bacterial peritonitis or SBP) or spread from elsewhere in the digestive tract
following a rupture.
So they can be classified into primary and secondary causese .

PRIMARY CAUSES :

1- spontataneous peritonitis of childhood

2- spontataneous peritonitis
3- tuberclous pertonitis
4- pertonitis associated with dialysis
 PRIMARY CAUSES :

1- spontataneous peritonitis of childhood

2- spontataneous peritonitis
3- tuberclous pertonitis
4- pertonitis associated with dialysis
 Secondary causes :
the term refers to peritonitis from an intra-abdominal source and is the most
common form of perotintis , the causes are :
1- perforation of hollow viscus (perforated dudenal ulcer ,gastric ulcer , perforated
enteric ulcer ,tubercular ulcer ,perforated Meckel's diverticulum, perforated colonic
ulcer)
2- direct spread : post-inflammatory ( acute cholecystitis -gangrenous ,acute
appenndicitis ,gangrene of the intestine and acute necrotizing pancrititis
3- penetrating injyries to the abdomen (where the organisms get entery from
outside )
4- postoperative peritonitis (infection during surgery
5- parturition perotinitis (after pregnancy and delivery )
6- blunt injuries to the abdomen (fluid which is spilled into the peritoneal cavity )
SYMPTOMS OF PERITONITIS
Severe abdominal pain or
tenderness
Bloating
Fever and chills (indicates a
septicaemic process )
Nausea and persistent vomiting
Loss of appetite
Diarrhea
Increased thirst
Passing significantly less urine
Inability to pass stool or gas
Fatigue
The pulse rate is increased
 COMPLICATIONS OF PERITONITIS

Severe hypovolaemic shock giving rise to renal

failure. It can be prevented by adequate
hydration of the patients and careful usage of
antibiotics such as gentamicin.
Septic shock, multiorgan failure and death
occur in late cases of peritonitis.
Subacute intestinal obstruction due to
postoperative adhesions.
Pelvic abscess
Subphrenic abscess
 DIAGNOSIS
(ground glass appearance a smooth homogeneous appearance
due to accumulation of fluid ) (Air in the bowel wall-
Complete blood picture shows gangrene)Obliteration of psoas shadow and preperitoneal fat
high total count with planes.
Abdominal USG to detect fluid in the abdomen .
predominant neutrophil count. Following are different fluids which may give clue to the
Blood examination for sugar is diagnosis Frank pus peritonitis of more than 48 hours
done to rule out diabetes old Bile green coloured— duodenum, s
tomach, gall bladder perforation
mellitus. Faeculent dark green coloured thick aspirate with faecal odour
Empyema gall bladder with or ileal perforations, postoperative anastomotic leaks
without perforation can present Serous exudative early acute pancreatitis, tuberculous peritonitis
Haemorrhagic haemorrhagic pancreatitis
as septic shock. Often, they are Food particles hollow viscus perforation
diabetic. Thus ultrasound has so many advantages even though it may
Plain X-ray abdomen, chest and not point at the specific site. However, probe tenderness with
fluid in the right iliac fossa may suggest acute appendicular
upright (Gas under the perforation. Very thick contents such as anchovy sauce from
diaphragm—perforation) ruptured amoebic liver abscess cannot be aspirated.
However, ultrasound will give clue about the liver abscess.
5. Abdominal tap Aspiration of blood indicates haemoperitoneum or
gangrene of the bowel. Aspiration of bile indicates biliary peritonitis
due to perforation of duodenal ulcer, gall bladder or intestine.
Aspiration of frank pus indicates peritonitis due to gram-negative
bacteria. Foul-smelling pus is due to anaerobic bacteria producing
free fatty acids and their esters. Always send the fluid for culture
sensitivity Amylase estimation should be done to rule out
pancreatitis.
6. Contrast-enhanced CT scan
When the signs and symptoms are equivocal, CT is the ideal
investigation.
CT can diagnose hollow viscus perforation, especially when there
is no gas under the diaphragm.
CT can detect ischaemic changes due to gangrene of the bowel-
gas in the bowel wall
7. Diagnostic laparoscopy can be used for in
suspected cases of peritonitis
it can be used to reconfirm peritonitis
it can diagnose pancreatitis
it can also treat primary cause e.g
laparoscopic closure of duodenal ulcer be
given
it can rule out other causes
in blunt injury it can be detect
diaphranatic injry heniation of bowel
RECOVERY AND PROGNOSIS

The prognosis for peritonitis

depends on factors such as the
underlying cause, timeliness of
treatment, and the overall
health of the patient. Recovery
may take time and require
ongoing medical care.
 TREATMENT OPTIONS
Treatment includes : antibiotic therapy, surgery, and
other procedures based on severity and symptoms.
Exploratory laparotomy and appropriate
Aspiration: Nasogastric aspiration with
surgery is done followed by thorough
Ryle's tube helps in decreasing
peritoneal toilet/wash with normal saline.
gastrointestinal secretion. Thus it
Fluids—IV fluids are given before, durin and
reduces abdominal distension. It also
prevents vomiting and gives rest to the after surgery. Central venous cannulation
gut. Indirectly it reduces "bacterial load' and measurement of central venous
contaminating peritoneum. pressure (CVP) is indicated in unstable
Bowel care and blood: Purgatives should patients to guide fluid therapy. If not
not be given as it may result in possible, an emergency cut down
perforation. Blood is arranged for (venesection ) cephalic or basilic vein is
surgery. done followed by fluid infusion .
Charts: Temperature, pulse rate,
respiratory rate, intake-output charts SELCTION OF ANTIBIOTICS : 2nd or 3rd generation
cephalosporins should be started as early as possible Once
are maintained. culture and sensitivity reports are available (after surgery),
Drugs are given against gram-positive, antibiotics can be changed Antibiotics should also cover
gram-negative and anaerobic aerobes and anaerobes Should not have serious toxicity,
organisms especially amikacin which has nephrotoxicity. Hence, to be
used carefully (check creatinine)
PREVENTION OF PERITONITIS

Preventive measures for

peritonitis include proper
wound care, hygiene
practices, and prompt
treatment of abdominal
injuries. These measures
can help reduce the risk
of peritonitis.
 Thank you

reference :
Manipal Manual of surgery