Peritonitis Classification and external resources
ICD-10	K65.
ICD-9	567
DiseasesDB	9860
eMedicine	med/2737
MeSH	D010538

This article is concerned with peritonitis in human beings. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books For a specific cause of peritonitis in cats, see feline infectious peritonitis. Feline infectious peritonitis (FIP is a fatal incurable disease that affects Cats It is believed by some to be caused by Feline Infectious Peritonitis Virus (FIPV which

Peritonitis is defined as inflammation of the peritoneum (the serous membrane which lines part of the abdominal cavity and some of the viscera it contains). Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal In Anatomy, a serous membrane (or serosa) is a smooth membrane consisting of a thin layer of cells which excrete Serous fluid In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. In Anatomy, a viscus (ˈvɪskəs ( Plural: viscera /ˈvɪsərə/ is an internal organ of an animal (including humans in particular an internal It may be localised or generalised, generally has an acute course, and may depend on either infection (often due to rupture of a hollow viscus) or on a non-infectious process. An infection is the detrimental Colonization of a host Organism by a foreign Species. In Anatomy, a viscus (ˈvɪskəs ( Plural: viscera /ˈvɪsərə/ is an internal organ of an animal (including humans in particular an internal Peritonitis generally represents a surgical emergency. Surgical emergency is a Medical emergency which requires immediate surgical intervention (the only way to solve the problem successfully

Contents 1 Mechanisms and manifestations 1.1 Abdominal pain and tenderness 1.2 Collateral manifestations 1.3 Complications 2 Diagnosis and investigations 3 Causes 3.1 Infected peritonitis 3.2 Non-infected peritonitis 4 Treatment 5 Prognosis 6 Pathology 7 References

Mechanisms and manifestations

Abdominal pain and tenderness

The main manifestations of peritonitis are acute abdominal pain, tenderness, and guarding, which are exacerbated by moving the peritoneum, e. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease In Medicine, tenderness is Pain or Discomfort when an affected area is touched Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them g. coughing, flexing the hips, or eliciting the Blumberg sign (a. Blumberg's sign is a sign that is elicited during physical examination in Medicine. k. a. rebound tenderness, meaning that pressing a hand on the abdomen elicits no pain, but releasing the hand abruptly will aggravate the pain, as the peritoneum snaps back into place). Rebound tenderness is a clinical sign that a doctor may detect in physical examination of a patient's Abdomen. The localization of these manifestations depends on whether peritonitis is localized (e. g. appendicitis or diverticulitis before perforation), or generalized to the whole abdomen; even in the latter case, pain typically starts at the site of the causing disease. Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Diverticulitis is a common Digestive disease particularly found in the Large intestine. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. Peritonitis is an example of acute abdomen. The term acute abdomen refers to a sudden severe Abdominal pain that is less than 24 hours in duration

Collateral manifestations

• Diffuse abdominal rigidity ("washboard abdomen") is often present, especially in generalized peritonitis;
• Fever;
• Sinus tachycardia;
• Development of ileus paralyticus (i. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Sinus Tachycardia (also colloquially known as sinus tach or sinus tachy) is a rhythm with elevated rate of impulses originating from the Sinoatrial Ileus is a disruption of the normal propulsive gastrointestinal motor activity from non-mechanical mechanisms e. intestinal paralysis), which also causes nausea and vomiting;

Complications

• Sequestration of fluid and electrolytes, as revealed by decreased central venous pressure, may cause electrolyte disturbances, as well as significant hypovolaemia, possibly leading to shock and acute renal failure. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the FLUID ( F ast L ight '''U'''ser '''I'''nterface D esigner is a graphical editor that is used to produce FLTK Source code An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Central venous pressure (CVP describes the pressure of blood in the thoracic Vena cava, near the Right atrium of the heart Electrolytes play a vital role in maintaining Homeostasis within the body In Physiology and Medicine, hypovolemia (also hypovolaemia is a state of decreased Blood volume more specifically decrease in volume of Blood plasma Acute renal failure ( ARF) also known as acute kidney failure or acute kidney injury, is a rapid loss of Renal function due to damage to the
• A peritoneal abscess may form (e. g. above or below the liver, or in the lesser omentum). The liver is a vital organ in the human body and is present in Vertebrates and some other animals
• Sepsis may develop, so blood cultures should be obtained. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused Blood culture is Microbiological culture of Blood. It is employed to detect Infections that are spreading through the bloodstream ( Bacteremia,
• the fluid may push on the diaphragm and cause breathing difficulties

Diagnosis and investigations

A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay surgery. Diagnosis is the identification by Process of elimination, of the nature of anything Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Leukocytosis and acidosis may be present, but they are not specific findings. Leukocytosis is a raised white blood cell count (the Leukocyte count above the normal range Acidosis is an increased Acidity (ie an increased Hydrogen ion Concentration) Plain abdominal X-rays may reveal dilated, oedematous intestines, although it is mainly useful to look for pneumoperitoneum (free air in the peritoneal cavity), which may also be visible on chest X-rays. Pneumoperitoneum is air or gas in the abdominal (peritoneal cavity A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e. Diagnostic peritoneal lavage ( DPL) is performed when intra-abdominal bleeding ( Hemoperitoneum) usually secondary to trauma is suspected g. in cause of trauma, in order to look for white blood cells, red blood cells, or bacteria). Treatment of physical trauma is described here and in First aid. Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have

Causes

Infected peritonitis

• Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal oesophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma, of the duodenum (peptic ulcer), of the remaining intestine (e. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in Boerhaave syndrome (also called Boerhaave's syndrome) or Esophageal perforation, is rupture of the esophageal wall In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Stomach or gastric cancer can develop in any part of the Stomach and may spread throughout the stomach and to other organs particularly the Esophagus and In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists g. appendicitis, diverticulitis, Meckel diverticulum, Inflammatory bowel disease (IBD), intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Diverticulitis is a common Digestive disease particularly found in the Large intestine. A Meckel's diverticulum, a true Congenital Diverticulum, is a small bulge in the small intestine present at birth In Medicine, inflammatory bowel disease ( IBD) is a group of inflammatory conditions of the large intestine and Small intestine Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and Meconium peritonitis refers to rupture of the bowel prior to birth resulting in fetal stool ( Meconium) escaping into the surrounding space ( Peritoneum The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process Cholecystitis is Inflammation of the Gall bladder. Causes and pathology Cholecystitis is often caused by Cholelithiasis (the presence of Other possible reasons for perforation include trauma, ingestion of sharp foreign body (such as a fish bone, toothpick or glass shard), perforation by an endoscope or catheter, and anastomotic leakage. Treatment of physical trauma is described here and in First aid. In Physiology, a foreign body (Latin corpus alienum) is any object originating outside the body Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. In Medicine a catheter is a tube that can be inserted into a body cavity duct or vessel 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. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease Ileus is a disruption of the normal propulsive gastrointestinal motor activity from non-mechanical mechanisms The term abdominal surgery broadly covers surgical procedures that involve opening the Abdomen. In most cases of perforation of a hollow viscus, mixed bacteria are isolated; the most common agents include Gram-negative bacilli (e. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Gram-negative bacteria are those Bacteria that do not retain Crystal violet dye in the Gram staining protocol Bacilli specifically refers to a taxonomic class of Bacteria. g. Escherichia coli) and anaerobic bacteria (e. An anaerobic organism is any Organism that does not require Oxygen for growth and may even die in its presence g. Bacteroides fragilis). Bacteroides is a Genus of Gram-negative, bacillis bacteria. Bacteroides species are non- Endospore -forming anaerobes Fecal peritonitis results from the presence of faeces in the peritoneal cavity. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus It can result from abdominal trauma and occurs if the large bowel is perforated during surgery. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces.
• 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. In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal A microorganism (also spelled micro organism or micro-organism and also called a microbe) is an Organism that is Microscopic (usually Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, intra-peritoneal chemotherapy. Treatment of physical trauma is described here and in First aid. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Introduction Current treatment options for patients with severe chronic kidney failure are Dialysis and kidney transplantation Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. 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. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Staphylococcus aureus (ˌstæfɨləˈkɒkəs ˈɔriəs literally "Golden Cluster Seed" and also known as golden staph) is the most common cause of Coagulase is an Enzyme produced by Staphylococcus aureus that converts Fibrinogen to Fibrin. Staphylococcus (in Greek σταφυλη staphyle means bunch of grapes and κοκκος coccos means granule is a genus of Gram-positive A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ
• 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. CHILD syndrome (or congenital hemidysplasia with ichthyosiform erythroderma and limb defects) is a genetic disorder In Medicine ( Gastroenterology) ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more See the article on spontaneous bacterial peritonitis for more information. Spontaneous bacterial peritonitis (SBP is a form of Peritonitis that occurs in patients with Cirrhosis.
• Systemic infections (such as tuberculosis) may rarely have a peritoneal localisation. Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common

Non-infected peritonitis

• Leakage of sterile body fluids into the peritoneum, such as blood (e. Sterilization (or sterilisation, see spelling differences) refers to any process that effectively kills or eliminates transmissible agents (such as Fungi Bodily fluids listed below are found in the bodies of men and/or women Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products g. endometriosis, blunt abdominal trauma), gastric juice (e. Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus Treatment of physical trauma is described here and in First aid. Gastric juice is a strong Acidic liquid PH 1 to 3 in humans which is close to being colourless g. peptic ulcer, gastric carcinoma), bile (e. A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Stomach or gastric cancer can develop in any part of the Stomach and may spread throughout the stomach and to other organs particularly the Esophagus and Bile or gall is a bitter yellow or green Alkaline fluid secreted by Hepatocytes from the Liver of most Vertebrates In many species g. liver biopsy), urine (pelvic trauma), menstruum (e. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Treatment of physical trauma is described here and in First aid. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the g. salpingitis), pancreatic juice (pancreatitis), or even the contents of a ruptured dermoid cyst. Salpingitis is an Infection and Inflammation in the Fallopian tubes. Pancreatic juice is a juice produced by the Pancreas. It contains a variety of Enzymes, including Trypsinogen, Chymotrypsinogen, Elastase Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details See also Teratoma A dermoid cyst is a Cystic Teratoma that contains developmentally mature Skin complete with Hair follicles 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. Bodily fluids listed below are found in the bodies of men and/or women
• Sterile abdominal surgery normally causes localised or minimal generalised peritonitis, which may leave behind a foreign body reaction and/or fibrotic adhesions. Adhesions are fibrous bands that form between tissues and organs often as a result of injury during surgery Obviously, peritonitis may also be caused by the rare, unfortunate case of a sterile foreign body inadvertently left in the abdomen after surgery (e. Aseptic technique refers to a procedure that is performed under sterile conditions In Physiology, a foreign body (Latin corpus alienum) is any object originating outside the body In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental g. gauze, sponge). Gauze is a thin Translucent fabric with a loose open Weave. Its name may derive etymologically from the Persian word for The sponges or poriferans (from Latin porus "pore" and ferre "to bear" are Animals
• Much rarer non-infectious causes may include familial Mediterranean fever, porphyria, and systemic lupus erythematosus. Familial Mediterranean fever (FMF is a hereditary inflammatory disorder that affects groups of patients originating from around the Mediterranean Sea (hence Porphyrias are a group of inherited or acquired disorders of certain Enzymes in the Heme biosynthetic pathway (also called Porphyrin pathway Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming

Treatment

Depending on the severity of the patient's state, the management of peritonitis may include:

• General supportive measures such as vigorous intravenous rehydration and correction of electrolyte disturbances. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Rehydration is the replenishment of Water, or water and Electrolytes lost through Dehydration. Electrolytes play a vital role in maintaining Homeostasis within the body
• Antibiotics are usually administered intravenously, but they may also be infused directly into the peritoneum. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. The empiric choice of broad-spectrum antibiotics often consist of multiple drugs, and should be targeted against the most likely agents, depending on the cause of peritonitis (see above); once one or more agents are actually isolated, therapy will of course be targeted on them. The term broad-spectrum antibiotic refers to an Antibiotic with activity against a wide range of disease-causing Bacteria.
• Surgery (laparotomy) is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage which may have caused peritonitis. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental A laparotomy is a surgical procedure involving an incision through the Abdominal wall to gain access into the Abdominal cavity. In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal ^[1] The exception is spontaneous bacterial peritonitis, which does not benefit from surgery. Spontaneous bacterial peritonitis (SBP is a form of Peritonitis that occurs in patients with Cirrhosis. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental

Prognosis

If properly treated, typical cases of surgically correctable peritonitis (e. g. perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48h). A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Diverticulitis is a common Digestive disease particularly found in the Large intestine. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity A patient is any person who receives medical attention care or treatment. Old age consists of ages nearing or surpassing the Average life span of Human beings and thus the end of the human life cycle. Illness (sometimes referred to as ill-health or ail) can be defined as a state of poor Health. If untreated, generalised peritonitis is almost always fatal.

Pathology

The peritoneum normally appears greyish and glistening; it becomes dull 2-4 hours after the onset of peritonitis, initially with scarce serous or slightly turbid fluid. In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal In Physiology, the term serous fluid is used for various Bodily fluids that are typically pale yellow and transparent and of a Benign nature Turbidity is the cloudiness or haziness of a fluid caused by individual particles ( suspended solids) that are generally invisible to the Naked eye Later on, the exudate becomes creamy and evidently suppurative; in dehydrated patients, it also becomes very inspissated. An exudate is any Fluid that filters from the Circulatory system into Lesions or areas of Inflammation. Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial The quantity of accumulated exudate varies widely. An exudate is any Fluid that filters from the Circulatory system into Lesions or areas of Inflammation. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera. In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal In Anatomy, a viscus (ˈvɪskəs ( Plural: viscera /ˈvɪsərə/ is an internal organ of an animal (including humans in particular an internal Inflammation features infiltration by neutrophils with fibrino-purulent exudation. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of White blood cells in humans and form an essential part of the

References

1. ^ Peritonitis: Emergencies: Merck Manual Home Edition. Retrieved on 2007-11-25. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1034 - Máel Coluim mac Cináeda, King of Scots dies Donnchad, the

• Peritonitis disease causes, treatment ...
• All Refer Health article on peritonitis
• Genuit T and Napolitano L. 2004. Peritonitis and Abdominal Sepsis. Emedicine. com
• Health square. 2004. Peritonitis.

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