Peritonitis

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Peritonitis
Classification and external resources
ICD-10K65
ICD-9567
MedlinePlus001335
eMedicinemed/2737
MeSHD010538
 
  (Redirected from Acute peritonitis)
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This article is about peritonitis in human beings. For a specific cause of peritonitis in cats, see Feline infectious peritonitis.
Peritonitis
Classification and external resources
ICD-10K65
ICD-9567
MedlinePlus001335
eMedicinemed/2737
MeSHD010538

Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized, and may result from infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process.

Signs and symptoms[edit]

Abdominal pain and tenderness[edit]

The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place). The presence of these signs in a patient is sometimes referred to as peritonism.[1] The localization of these manifestations depends on whether peritonitis is localized (e.g., appendicitis or diverticulitis before perforation), or generalized to the whole abdomen. In either case, pain typically starts as a generalized abdominal pain (with involvement of poorly localizing innervation of the visceral peritoneal layer), and may become localized later (with the involvement of the somatically innervated parietal peritoneal layer). Peritonitis is an example of an acute abdomen.

Collateral manifestations[edit]

Complications[edit]

Causes[edit]

Infected peritonitis[edit]

Non-infected peritonitis[edit]

Diagnosis[edit]

A diagnosis of peritonitis is based primarily on the clinical manifestations described above. If peritonitis is strongly suspected, then surgery is performed without further delay for other investigations. Leukocytosis, hypokalemia, hypernatremia, and acidosis may be present, but they are not specific findings. Abdominal X-rays may reveal dilated, edematous intestines, although such X-rays are mainly useful to look for pneumoperitoneum, an indicator of gastrointestinal perforation. The role of whole-abdomen ultrasound examination is under study and is likely to expand in the future. Computed tomography (CT or CAT scanning) may be useful in differentiating causes of abdominal pain. If reasonable doubt still persists, an exploratory peritoneal lavage or laparoscopy may be performed. In patients with ascites, a diagnosis of peritonitis is made via paracentesis (abdominal tap): More than 250 polymorphonucleate cells per μL is considered diagnostic. In addition, Gram stain is almost always negative, whereas culture of the peritoneal fluid can determine the microorganism responsible and determine their sensitivity to antimicrobial agents.

Pathology[edit]

In normal conditions, the peritoneum appears greyish and glistening; it becomes dull 2–4 hours after the onset of peritonitis, initially with scarce serous or slightly turbid fluid. Later on, the exudate becomes creamy and evidently suppurative; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated exudate varies widely. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera. Inflammation features infiltration by neutrophils with fibrino-purulent exudation.

Treatment[edit]

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

Prognosis[edit]

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 patient. The mortality rate rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48 hours).

If untreated, generalised peritonitis is almost always fatal.

Famous cases[edit]

On May 13, 1864, 21-year-old Private William Christman of Pennsylvania, who had died of peritonitis, became the first military man buried at Arlington.[citation needed] The Swiss Freudian psychiatrist and psychoanalyst Hermann Rorschach, best known for developing a projective test known as the Rorschach inkblot test, died of peritonitis in 1922 at the age of 37.[citation needed]

Famous magician and escape artist Harry Houdini died of peritonitis after a fan asked to punch him in the stomach, a practice that had become a part of Houdini's repertoire. Speculation remains in regard to the exact reason for the performer's death, but one medical professional has suggested that the punch caused a rupture in Houdini's intestine. Following Houdini's initial refusal of surgical treatment—four physicians tried to persuade him to undergo surgery—he died two days later on October 31, 1926, even though he eventually agreed to undergo surgery.[4][5]

Actor Rudolph Valentino died of peritonitis on August 23, 1926, after suffering a ruptured appendix. He also developed pleuritis in his left lung and died several hours after entering into a comatose state.[6][7]

Rhythm and blues singer Chuck Willis died from peritonitis in 1958 at the peak of his popularity.[citation needed]

References[edit]

  1. ^ "Biology Online's definition of peritonism". Retrieved 2008-08-14. 
  2. ^ Appropriate Prescribing of Oral Beta-Lactam Antibiotics
  3. ^ "Peritonitis: Emergencies: Merck Manual Home Edition". Retrieved 2007-11-25. 
  4. ^ Kalush, William; Sloman, Larry (October 2006). The Secret Life of Houdini: The Making of America's First Superhero. Simon & Schuster. ISBN 978-0-7432-7207-0. 
  5. ^ SmarterEveryDay (26 December 2013). "How Houdini DIED (in Slow Motion) - Smarter Every Day 108" (Video upload). SmarterEveryDay on YouTube. Google, Inc. Retrieved 30 May 2014. 
  6. ^ "Valentino Loses Battle With Death: Greatest of Screen Lovers Fought Valiantly For Life" (PDF). The Plattsburgh Sentinel. Associated Press. August 24, 1926. p. 1. Retrieved 2010-05-15. 
  7. ^ Gilbert King (13 June 2012). "The “Latin Lover” and His Enemies". Smithsonian.com. Smithsonian Institution. Retrieved 30 May 2014. 

External links[edit]