Peritonitis: Difference between revisions

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==Mechanisms & manifestations==
==Mechanisms & manifestations==
===Abdominal pain & tenderness===
The main manifestations of peritonitis are acute '''abdominal [[abdominal pain|pain]], [[abdominal tenderness|tenderness]], and [[abdominal guarding|guarding]]''', which are exacerbated by moving the peritoneum, e.g. coughing, flexing the hips, or eliciting the [[Blumberg sign]] (a.k.a. [[rebound tenderness]], meaning that pressing a hand on the abdomen elicits pain, but releasing the hand abruptly will aggravate the pain, as the peritoneum snaps back into place). The localisation of these manifestations depends on whether peritonitis is localised (e.g. [[appendicitis]] or [[diverticulitis]] before perforation), or generalised to the whole [[abdomen]]; even in the latter case, pain typically starts at the site of the causing disease. Peritonitis is an example of [[acute abdomen]].
===Collateral manifestations===
* Diffuse abdominal rigidity ("washboard abdomen") is often present, especially in generalised peritonitis;
* [[Fever]];
* [[Sinus tachycardia]];
* Development of [[ileus|ileus paralyticus]] (i.e. intestinal paralysis), which also causes [[nausea]] and [[vomiting]];


==Diagnosis and investigations==
==Diagnosis and investigations==

Revision as of 15:48, 6 February 2012

For patient information click here

Peritonitis
ICD-10 K65
ICD-9 567
DiseasesDB 9860
MeSH D010538

Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Mechanisms & manifestations

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. Leukocytosis and acidosis may be present, but they are not specific findings. 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. If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e.g. in cause of trauma, in order to look for white blood cells, red blood cells, or bacteria).

Causes

Treatment

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). If untreated, generalised peritonitis is almost always fatal.

Pathology

References

Additional Resources

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