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==Differential diagnosis==
==Differential diagnosis==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center class="wikitable" style="border: 2; background: none;"
! colspan="2" rowspan="2" style="border: 1; background: 1;" | Classification of acute abdomen based on etiology
! colspan="1" rowspan="2" |Presentation
! colspan="4" rowspan="1" | Symptoms
! colspan="3" rowspan="1" | Signs
! colspan="2" rowspan="1" | Diagnosis
! colspan="1" rowspan="2" | Additional Findings
|-
! colspan="1" rowspan="1"| Fever || Abdominal Pain || Diarrhea || Constipation
! colspan="1" rowspan="1"| Guarding || Rebound Tenderness || Bowel sounds
! colspan="1" rowspan="1"| Lab Findings || Imaging Findings
|-
! colspan="1" rowspan="8" | Common causes of Peritonitis
! colspan="1" | Primary Peritonitis
| colspan="1" rowspan="1" | Spontateous Bacterial Peritonitis
|✔
|Diffuse
|✘
|✘
|✘
|✘
|Diminished
|'''Ascitic fluid''' PMN
>250cells/mm<small>³</small>
'''Culture''': Positive for single organism
|
|
|-
! colspan="1" rowspan="7" | Secondary Peritonitis
| colspan="1" rowspan="1" | Perforated gastric and duodenal ulcer || ✔
||  Diffuse
|| ✘
||✘
|✔
|✔
|✘
|Glucose
< 50mg/dl
Ascitic fluid LDH > serum LDH
Total Protein
> 1g/dl
|
|
|-
| colspan="1" rowspan="1" |  Acute Cholangitis || ✔
|| RUQ
|| ✘
|| ✘
|✘
|✘
|N
|Increased LFT
|
|
|-
| colspan="1" rowspan="1" | Acute Cholecystitis || ✔
|| RUQ
||  ✘
|| ✘
|✘
|✘
|N
|
|
|
|-
| colspan="1" rowspan="1" |  Acute Pancreatitis || ✔
|| Diffuse
||  ✔
|| ✘
|✘
|✘
|N
|Increased Amylase / Lipase
|
|
|-
| colspan="1" rowspan="1" | Acute Appendicitis || ✔
|| RLQ
|| ✘
|| ✘
|✘
|✔
|N
|
|
|-
| colspan="1" rowspan="1" | Acute Diverticulitis || ✔
|| LLQ
|| ✔/✘
|| ✔/✘
|✘
|✘
|N
|
|
|
|-
| colspan="1" rowspan="1" | Acute Salphingitis || ✔
|| LLQ/ RLQ
|| ✘
|| ✘
|✔/✘
|✔/✘
|N
|
|
|
|-
! colspan="2" rowspan="4" | Hollow Viscous Obstruction
| colspan="1" rowspan="1" |Small Intestine obstruction
|✘
|Diffuse
|✘
|✔✔
|✘
|✘
|Absent
|
|
|
|-
|Volvulus
|
|LLQ
|
|
|
|
|
|
|
|
|-
|Biliary Colic
|
|RUQ
|
|
|
|
|
|
|
|
|-
|Renal Colic
|
|Flank Pain
|
|
|
|
|
|
|
|
|-
! rowspan="4" |Vascular Disorders
! rowspan="2" |Ischemic causes
|Mesentric Ischemia
|
|Periumbilical
|
|
|
|
|
|Increased AG Acidosis
|
|
|-
|Acute Ischemic Colitis
|
|
|
|
|
|
|
|
|
|
|-
! rowspan="2" |Hemorrhagic causes
|Ruptured Abdominal Aortic Aneurysm
|
|Diffuse
|
|
|
|
|
|
|
|
|-
|Intraabdominal or Retroperitoneal Hemorrhage
|
|Diffuse
|
|
|
|
|
|
|
|
|-
! rowspan="3" |Gynaecological Causes
! rowspan="2" |Ovarian Cyst Complications
|Torsion of the Cyst
|
|RLQ / LLQ
|
|
|
|
|
|
|
|
|-
|Cyst Rupture
|
|RLQ / LLQ
|
|
|
|
|
|
|
|
|-
!Pregnancy
|Ruptured Ectopic Pregnancy
|
|RLQ / LLQ
|
|
|
|
|
|Positive Urine beta HCG
|
|
|-
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 12:36, 5 May 2017

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];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Causes


Common causes Less common causes
Spontaneous bacterial peritonitis
Secondary peritonitis


Classification

Peritonitis is classified based on the cause of the inflammatory process and the character of microbial contamination as follows:[1][2][3]

 
 
 
 
 
 
 
 
Peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary peritonitis
 
 
 
 
Secondary peritonitis
 
 
 
 
Tertiary peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Spontaneous peritonitis
❑ Peritonitis in patients with CAPD
❑ Tuberculous peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
❑ Peritonitis without evidence for pathogens
❑ Peritonitis with fungi
❑ Peritonitis with low-grade pathogenic bacteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute perforation peritonitis
❑ Gastrointestinal perforation
❑ Intestinal ischemia
❑ Pelviperitonitis and other forms
 
 
Postoperative peritonitis
❑ Anastomotic leak
❑ Accidental perforation and devascularization
 
 
Post-traumatic peritonitis
❑ After blunt abdominal trauma
❑ After penetrating abdominal trauma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Differential diagnosis

Classification of acute abdomen based on etiology Presentation Symptoms Signs Diagnosis Additional Findings
Fever Abdominal Pain Diarrhea Constipation Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Findings
Common causes of Peritonitis Primary Peritonitis Spontateous Bacterial Peritonitis Diffuse Diminished Ascitic fluid PMN

>250cells/mm³

Culture: Positive for single organism

Secondary Peritonitis Perforated gastric and duodenal ulcer Diffuse Glucose

< 50mg/dl

Ascitic fluid LDH > serum LDH

Total Protein

> 1g/dl

Acute Cholangitis RUQ N Increased LFT
Acute Cholecystitis RUQ N
Acute Pancreatitis Diffuse N Increased Amylase / Lipase
Acute Appendicitis RLQ N
Acute Diverticulitis LLQ ✔/✘ ✔/✘ N
Acute Salphingitis LLQ/ RLQ ✔/✘ ✔/✘ N
Hollow Viscous Obstruction Small Intestine obstruction Diffuse ✔✔ Absent
Volvulus LLQ
Biliary Colic RUQ
Renal Colic Flank Pain
Vascular Disorders Ischemic causes Mesentric Ischemia Periumbilical Increased AG Acidosis
Acute Ischemic Colitis
Hemorrhagic causes Ruptured Abdominal Aortic Aneurysm Diffuse
Intraabdominal or Retroperitoneal Hemorrhage Diffuse
Gynaecological Causes Ovarian Cyst Complications Torsion of the Cyst RLQ / LLQ
Cyst Rupture RLQ / LLQ
Pregnancy Ruptured Ectopic Pregnancy RLQ / LLQ Positive Urine beta HCG

References

  1. Wittmann DH, Schein M, Condon RE (1996). "Management of secondary peritonitis". Ann Surg. 224 (1): 10–8. PMC 1235241. PMID 8678610.
  2. Nathens AB, Rotstein OD, Marshall JC (1998) Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg 22 (2):158-63. PMID: 9451931
  3. Mishra SP, Tiwary SK, Mishra M, Gupta SK (2014) An introduction of Tertiary Peritonitis. J Emerg Trauma Shock 7 (2):121-3. DOI:10.4103/0974-2700.130883 PMID: 24812458