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Peritonitis: Difference between revisions
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Generalised peritonitis occurs due to: | Generalised peritonitis occurs due to: | ||
* Perforation of an abdominal organ | * [[Gastrointestinal perforation|Perforation of an abdominal organ]] | ||
** Perforated duodenal ulcer | ** Perforated duodenal ulcer | ||
** Perforated appendicitis | ** Perforated appendicitis | ||
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* Abdominal organ inflammation with spread to adjacent peritoneum | * Abdominal organ inflammation with spread to adjacent peritoneum | ||
** Appendicitis | ** [[Acute appendicitis|Appendicitis]] | ||
** Diverticulitis | ** [[Diverticular disease (diverticulosis and diverticulitis)|Diverticulitis]] | ||
** Pancreatitis | ** [[Acute pancreatitis|Pancreatitis]] | ||
== Clinical features == | == Clinical features == | ||
Peritonitis causes abdominal pain. Movement usually worsens the pain, causing the patient to lie completely still, usually with the knees bent. Even gentle percussion over the affected area of the abdomen causes pain. “Guarding” on palpation, as well as rebound tenderness, are typical signs of peritonitis. The heel-drop test may be positive. | Peritonitis causes peritonitic abdominal pain. Movement usually worsens the pain, causing the patient to lie completely still, usually with the knees bent. Even gentle percussion over the affected area of the abdomen causes pain. “Guarding” on palpation, as well as rebound tenderness, are typical signs of peritonitis. The heel-drop test may be positive. | ||
If generalised, peritonitis also causes signs of infection like fever. | If generalised, peritonitis also causes signs of infection like fever. | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
The presence of peritonitis is usually established by physical examination, but the underlying cause must be sought. Stable patients should undergo imaging (x-ray, CT, ultrasonography) to identify the underlying cause. However, unstable or very ill-appearing patients may skip imaging to avoid delaying surgery. | The presence of peritonitis is usually established by physical examination, but the underlying cause must be sought. Stable patients should undergo imaging ([[x-ray]], [[CT]], [[ultrasonography]]) to identify the underlying cause. However, unstable or very ill-appearing patients may skip imaging to avoid delaying surgery. | ||
== Treatment == | == Treatment == | ||
The treatment of generalised peritonitis involves supportive therapy, empiric wide-spectrum antibiotics, and treatment of the underlying cause, which almost always requires surgery. Local peritonitis does not invariably require antibiotics, for example when caused by appendicitis. | The treatment of generalised peritonitis involves supportive therapy, empiric wide-spectrum antibiotics, and treatment of the underlying cause, which almost always requires surgery. Local peritonitis does not invariably require antibiotics, for example when caused by appendicitis. | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||