What is Surgery – Peritonitis Signs and Symptoms
Peritonitis is an inflammation of the peritoneal lining of the abdominal cavity that can be localised or generalised, with the latter being either primary or secondary.
Appendicitis, cholecystitis, diverticulitis, and salpingitis are common causes. Bacterial infection of the peritoneal cavity with no evident focus is the primary cause. Streptococcus penumoniae can cause primary pneumococcal peritonitis in children. Adults with CAPD are frequently linked with cirrhosis and ascites (spontaneous bacterial peritonitis) or renal failure (continuous ambulatory peritoneal dialysis). Peritonitis spreads from a localised infective focus, either polymicrobial or nonbacterial, due to leakage of bile, blood, gastric contents, e.g. perforated peptic ulcer, pancreatic secretions (a chemical peritonitis that frequently becomes secondary infected).
Primary peritonitis is uncommon and usually affects adolescent females; however, localised and secondary generalised peritonitis are more prevalent.
An in-depth history of the origin, type, course, and spread of abdominal pain, as well as exacerbating, alleviating, and related factors, should be collected. Peritonitis causes persistent, sharp, localised pain that is aggravated by movement and coughing (parietal peritoneum is supplied by somatic A-fibers coming from T7–L2 spinal neurons).
Examine vital signs, evidence of dehydration, and signs of perfusion compromise (e.g., hypovolaemia, sepsis, or circulatory failure). Localised: Tenderness with involuntary guarding: reflex contraction of overlaying abdominal wall muscles; rebound tenderness: pain caused by movement of the inflamed peritoneum when a palpating hand is suddenly removed, comparable to percussion tenderness or pain provoked by coughing.
Generalized: The patient is frequently quite sick, with systemic indications of toxaemia or sepsis (e.g., fever, tachycardia); movement aggravates pain. Due to paralytic ileus, the abdomen is rigid with generalised guarding and rebound, and bowel sounds are attenuated or nonexistent.
As evidenced by the patient's medical history and clinical evaluation. FBC, U&Es, LFT, amylase, CRP, clotting, G&S or crossmatch, blood cultures, pregnancy test, and ABG (to check for metabolic acidosis, lactate levels, or respiratory failure).
Pneumoperitoneum is treated by an erect CXR. AXR is used to treat bowel blockage. To determine the cause of the peritonitis, a CT scan of the abdomen or a laparoscopy may be used. When the peritoneum is inflamed, it loses its lustrous aspect and becomes erythematous, producing copious serous inflammatory exudate that is rich in white blood cells, protein, and inflammatory mediators. The larger omentum adheres to the inflamed organ, forming a barrier to infection spread.
If you have ascites, you should: Gram stain and culture, ascitic tap and cell count (diagnostic of SBP if >250 neutrophils/mm3)
MANAGEMENT Localized: Treatment will be determined by the underlying cause (appendectomy in appendicitis), as well as IV antibiotics (cholecystitis, salpingitis, and most cases of acute diverticulitis).
Generalized: The patient is in danger of dying as a result of sepsis and shock. IV fluid resuscitation, volume and electrolyte balance correction, and IV antibiotics are required. To monitor fluid balance and surgical intervention, a urinary catheter, NG tube, and CVP line are used. To identify and treat the source, remove infected or necrotic tissue, and perform profuse peritoneal lavage, an urgent laparotomy/laparoscopy is required. Acute non-necrotising pancreatitis is an exception. Primary peritonitis is treated with antibiotics, however the diagnosis is often missed until after operational intervention has been attempted.
Septic shock, respiratory or multi-organ failure, paralytic ileus, wound infection, tertiary peritonitis (persistence of intra-abdominal infection), abscesses, portal pyaemia/hepatic abscesses are all common early complications.
Late complications: adhesions and incisional hernia.
Localised peritonitis usually goes away with proper treatment of the underlying cause. Generalised peritonitis has a substantially greater fatality rate, which can be as high as 30–50%. The development of septic shock or multi-organ dysfunction at the same time can increase the mortality rate to more than 70%. With the right antibiotics, primary peritonitis has an excellent prognosis. If diagnosis and treatment are delayed, the total death rate of patients with SBP may surpass 30%.
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