PERITONITI

S
By: Nur Dini Athirah bt Mohd Sakry
012014050532

DEFINITION & TYPES

Peritonitis is inflammation of the peritoneum

caused by infection from bacteria and fungi

Types:
Primary peritonitis-caused by the spread of an
infection from the blood and lymph nodes to the
peritoneum(rare,<1%)

Secondary peritonitis-when the infection comes

into the peritoneum from gastrointestinal or
biliary tract (common)

ETIOLOGY
PRIMARY PERITONITIS
Usually caused by a liver disease. Fluid
builds up in the abdomen(ascites),creating
an environment for bacteria to grow

ETIOLOGY
SECONDARY PERITONITIS
Gastrointestinal perforation,eg: perforated
ulcer,diverticular perforation
Abdominal condition,eg:
appendicitis,diverticulitis,strangulation of
intestine,pancreatitis, pelvic inflammatory
disease,mesenteric ischemia
Intra-peritoneal blood from any source, eg: ruptured
aneurysm,trauma,surgery,ectopic pregnancy
Peritoneal-systemic shunts, drains and dialysis
catheters in the peritoneal cavity

BACTERIA IN PERITONITIS
GASTROINTESTINAL SOURCE:
E Coli
Streptococci
Bacteriodes
Clostridium
Klebsiella Pneumoniae
Staphylococcus
OTHER SOURCES:
Chlamydia
Gonococcus
B Hemolytic Streptococci
Pneumococcus
Mycobacterium tuberculosis

SYMPTOMS
Dull abdominal pain persistent,severe
abdominal pain, pain worsened by
movement,sharp pain
Nausea and vomiting
Loss of appetite
Abdominal distension
Fever+chills
Urinary symptoms-oligouria (pelvic peritonitis)
Shoulder(phrenic) pain(if inflammation under
diaphragm)

SIGNS
Increase in temperature
Increase pulse rate
Guarding and rigidity of abdominal wall
Positive rebound tenderness
Tenderness on rectal/vaginal
examination(pelvic peritonitis)
Absent or reduced bowel sounds

COMPLICATIONS
Severe dehydration and electrolyte
disturbances
Untreared sepsis,adult respiratory distress
syndrome, multiple organ failures( kidney
failure,liver failure,resp failure,disseminated
intravascular coagulation)
Hippocratic face
Death occurs within days

PERITONITIS
Khairil Azlin Binti Kamal
012013050035

CONTENT
INVESTIGATION
TREATMENT
PROGNOSIS
COMPLICATIONS

Investigation
1.

Bloods :
Full blood count leucocytosis
Serum amylase to rule out acute
pancreatitis
Urea & electrolyte dehydration & acidosis
Group cross match & screen hold as
adjunct to impending surgery

2.

Imaging :
Erect chest X-ray to find air under
diaphragm (free sub-diaphragmatic
air)
Supine abdominal X-ray
Dilated gas-filled bowel loops in
paralytic ileus
Absence of faecal pattern in sites
of inflammation in diverticulitis
CT scan of abdomen to identify
cause of peritonitis & aids in
management plan (ex : surgical
strategy)

3. Invasive

4.

:
Peritoneal fluid analysis
Bedside test :
Urine dipstick to look for urinary tract
infection
ECG if patient have cardiac history or if
diagnostic doubt

Treatment

Depending on degree (localised/generalised),

duration and severity, patients will require
some or all of the following :
1.Fluid loss correction
2.Urinary catheterisation gastrointestinal
decompression
3.Antibiotic therapy parenteral broad
spectrum ABX.
4.Analgesia

Prognosis

With modern treatment, diffuse peritonitis

carries a 10% mortality rate.
Factors influencing the prognosis :
degree
and
duration
of
peritoneal
contamination
age and fitness of the patient
the nature of the underlying cause

Complication

Reference

Bailey & Loves Short Practice of Surgery 26th

Edition