Peritonitis is an inflammation of the serosa (called ‘peritoneum’) that lines the viscera and abdominal cavity, usually due to bacterial contamination

It is distinguished in:

• primary peritonitis (when there is no evidence of a localised infectious focus);
• secondary peritonitis (due to bacterial invasion or action of chemical agents starting from an infectious focus of the digestive tract, hepato-biliary-pancreatic system, uro-genital apparatus; due to necrosis or perforation of a hollow viscera; due to closed or open trauma).

What are the causes of peritonitis?

The main cause of bacterial peritonitis is internal perforation of the gastrointestinal tract, which leads to contamination of the abdominal cavity with gastric juices and/or intestinal contents.

The peritoneum reacts to any stimulus and defends itself against infection by circumscribing any inflammatory process.

Peritonitis has serious general repercussions that can be summarised as hypovolaemia (loss or sequestration of fluid) and sepsis (generalised infectious state).

Hypovolaemia arises due to a hydro-electrolyte loss in the intestine, which causes intestinal blockage or paresis (‘paretic ileus’); fluid recall from the extracellular compartment aggravates dehydration and hypovolaemia.

Transudate is formed, which sometimes changes to exudate, forming massive fluid and protein sequestrations.

Sepsis (generalised infectious state) and the accumulation of toxic substances absorbed by the organism can thus exert their action, causing severe haemodynamic instability (alterations in blood pressure and cardiac function) up to an overt picture of shock.

What are the symptoms of peritonitis?

The symptoms of acute peritonitis are:

• pain (intense, piercing, local or diffuse), many times forcing the patient to remain in the fetal position, limiting movement as much as possible;
• reaction of the abdominal wall (increased muscle tone or contracture);
• fever (> 38°C);
• nausea;
• vomiting.

Diagnosis of peritonitis

To make a diagnosis of peritonitis, it is important to carry out a correct objective test, combined with laboratory tests and imaging (X-ray, CT scan, ultrasound).

Altered laboratory values are:

• increased haematocrit,
• elevated azotemia,
• hyposodukaemia,
• neutrophil leukocytosis,
• reduced creatinine clearence,
• hypoalbuminemia,
• reduced coagulation factors,
• increased cell necrosis indices (GOT, GTP, LDH),
• hyperbilirubinemia,
• increased gammaglutamintransferase,
• alkaline phosphatase,
• hypoxemia,
• respiratory alkalosis,
• metabolic acidosis when hypovolemic or septic shock occurs.

Therapy is in most cases surgical and is based on resolving the specific causes that led to acute peritonitis.

In addition, any hydro-electrolyte imbalances will be corrected.

In severe cases, even surgery may be necessary.

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Source

Medicina Online