This article is concerned with peritonitis in human beings. For a specific cause of peritonitis in cats, see feline infectious peritonitis.

Peritonitis is defined as inflammation of the peritoneum (the serous membrane which lines part of the abdominal cavity and some of the viscera it contains). It may be localised or generalised, generally has an acute course, and may depend on either infection (often due to rupture of a hollow viscus) or on a non-infectious process. Peritonitis generally represents a surgical emergency. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... FIP-infected kidney showing inflammatory response Feline infectious peritonitis (FIP) is a fatal, incurable disease that affects cats. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... A serous membrane is a very thin layer of cells (usually one row) covering internal body cavity. ... For the human abdomen, see human abdomen. ... In anatomy, the viscera are the internal organs of an animal, in particular the internal organs of the head, thorax and abdomen. ... An infection is the detrimental colonization of a host organism by a foreign species. ... In anatomy, a viscus (plural viscera) is an internal organ of an animal, in particular an internal organ of the thorax or abdomen. ... Surgical emergency is a medical emergency which requires immediate surgical intervention (the only way to solve the problem successfully). ...

Mechanisms & manifestations

Abdominal pain & tenderness

The main manifestations of peritonitis are acute abdominal pain, tenderness, and 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. Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Definition of Abdominal guarding Abdominal guarding: Tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. ... Blumberg sign is indicative of peritonitis. ... Rebound tenderness is a clinical sign resulting from physical examination of the abdomen. ... Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix[1]. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. ... Diverticulitis is a common digestive disorder particularly found in the large intestine. ... For the human abdomen, see human abdomen. ... The term acute abdomen refers to a sudden, severe pain in the abdomen that is less than 24 hours in duration. ...

Collateral manifestations

• Diffuse abdominal rigidity ("washboard abdomen") is often present, especially in generalised peritonitis;
• Fever;
• Sinus tachycardia;
• Development of ileus paralyticus (i.e. intestinal paralysis), which also causes nausea and vomiting;

This article needs additional references or sources for verification. ... Sinus tachycardia is a rhythm with elevated rate of impulses originating from the SA node, defined as a rate greater than 100 beats/min in an average adult. ... Ileus, formerly called iliac passion, refers to limited or absent intestinal passage. ... For other uses, see Nausea (disambiguation). ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ...

Complications

• Sequestration of fluid and electrolytes, as revealed by decreased central venous pressure, may cause electrolyte disturbances, as well as significant hypovolaemia, possibly leading to shock and acute renal failure.
• A peritoneal abscess may form (e.g. above or below the liver, or in the lesser omentum).
• Sepsis may develop, so blood cultures should be obtained.

• the fluid may push on the diaphragm and cause breathing difficulties

A fluid is defined as a substance that continually deforms (flows) under an applied shear stress regardless of the magnitude of the applied stress. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ... Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. ... Electrolyte disturbance refers to an abnormal change in the levels of electrolytes in the body. ... In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... Shock is a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients. ... The liver is an organ present in vertebrates and some other animals. ... In higher vertebrates, the peritoneum is the membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Blood culture is microbiological culture of blood. ...

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). In general, a diagnosis (plural diagnoses) has two distinct dictionary definitions. ... “Surgeon” redirects here. ... Leukocytosis is an elevation of the white blood cell count (the leukocyte count) above the normal range. ... Acidosis is an increased acidity (i. ... Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity, usually seen on x-ray. ... Image A: A normal chest X-ray. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... White Blood Cells is also the name of a White Stripes album. ... Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen to body tissues via the blood. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ...

Causes

Infected peritonitis

• Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal oesophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma, of the duodenum (peptic ulcer), of the remaining intestine (e.g. appendicitis, diverticulitis, Meckel diverticulum, IBD, intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Other possible reasons for perforation include trauma, ingestion of sharp foreign body (such as a fish bone), perforation by an endoscope or catheter, and anastomotic leakage. The latter occurrence is particularly difficult to diagnose early, as abdominal pain and ileus paralyticus are considered normal in patients who just underwent abdominal surgery. In most cases of perforation of a hollow viscus, mixed bacteria are isolated; the most common agents include Gram-negative bacilli (e.g. Escherichia coli) and anaerobic bacteria (e.g. Bacteroides fragilis).
• Disruption of the peritoneum, even in the absence of perforation of a hollow viscus, may also cause infection simply by letting micro-organisms into the peritoneal cavity. Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, intra-peritoneal chemotherapy. Again, in most cases mixed bacteria are isolated; the most common agents include cutaneous species such as Staphylococcus aureus, and coagulase-negative staphylococci, but many others are possible, including fungi such as Candida.
• Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with ascites. See the article on spontaneous bacterial peritonitis for more information.
• Systemic infections (such as tuberculosis) may rarely have a peritoneal localisation.

The esophagus, oe/œsophagus*, or gullet is the muscular tube in vertebrates through which ingested food passes from the mouth area to the stomach. ... Boerhaave syndrome (also called Boerhaaves syndrome) is rupture of the esophagus. ... In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... A benign gastric ulcer (from the antrum) of a gastrectomy specimen. ... In medicine, stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube connecting the stomach to the jejunum. ... A benign gastric ulcer (from the antrum) of a gastrectomy specimen. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ... Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix[1]. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. ... Diverticulitis is a common digestive disorder particularly found in the large intestine. ... A Meckels diverticulum, a true congenital diverticulum, is a small bulge in the small intestine present at birth. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ... Meconium peritonitis refers to rupture of the bowel prior to birth, resulting in fetal stool (meconium) escaping into the surrounding space (peritoneum) leading to inflammation (peritonitis). ... The gallbladder (or cholecyst, sometimes gall bladder) is a pear-shaped organ that stores about 50 ml of bile (or gall) until the body needs it for digestion. ... Cholecystitis is inflammation of the gall bladder. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... The word Foreign means originating elsewhere or in the physiological context outside the body. ... Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Ileus, formerly called iliac passion, refers to limited or absent intestinal passage. ... The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Orders Bacillales Lactobacillales The term bacilli (singular bacillus) is used to refer to any rod-shaped bacteria. ... E. coli redirects here. ... An anaerobic organism or anaerobe is any organism that does not require oxygen. ... Species etc. ... In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... A microorganism or microbe is an organism that is so small that it is microscopic (invisible to the naked eye). ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Peritoneal dialysis In medicine, peritoneal dialysis is a method for removing waste such as urea and potassium from the blood, as well as excess fluid, when the kidneys are incapable of this (i. ... Chemotherapy is the use of chemical substances to treat disease. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Coagulase is an enzyme produced by Staphylococcus aureus to localize an area of residence that converts fibrinogen to fibrin. ... Species S. aureus Staphylococcus (in Greek staphyle means bunch of grapes and coccos means granule) is a genus of gram-positive bacteria. ... Divisions Chytridiomycota Zygomycota Ascomycota Basidiomycota The Fungi (singular: fungus) are a large group of organisms ranked as a kingdom within the Domain Eukaryota. ... Candida can have various meanings: Candida is a comedic play by George Bernard Shaw published in 1898 that satirizes socialist reformers in the Church of England. ... A male Caucasian toddler child A child (plural: children) is a young human. ... Spontaneous bacterial peritonitis is a form of peritonitis that occurs in patients with cirrhosis. ... Tuberculosis (abbreviated as TB for tubercle bacillus or TuBerculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ...

Non-infected peritonitis

• Leakage of sterile body fluids into the peritoneum, such as blood (e.g. endometriosis, blunt abdominal trauma), gastric juice (e.g. peptic ulcer, gastric carcinoma), bile (e.g. liver biopsy), urine (pelvic trauma), menstruum (e.g. salpingitis), pancreatic juice (pancreatitis), or even the contents of a ruptured dermoid cyst. It is important to note that, while these body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.
• Sterile abdominal surgery normally causes localised or minimal generalised peritonitis, which may leave behind a foreign body reaction and/or fibrotic adhesions. Obviously, peritonitis may also be caused by the rare, unfortunate case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge).
• Much rarer non-infectious causes may include familial Mediterranean fever, porphyria, and systemic lupus erythematosus.

Sterilization (or sterilisation) refers to any process that effectively kills or eliminates transmissible agents (such as fungi, bacteria, viruses and prions) from a surface, equipment, foods, medications, or biological culture medium. ... Bodily fluids are fluids, which are generally excreted or secreted from the human body. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Gastric juice is a strong acidic liquid, pH 1 to 3, which is close to being colourless. ... A benign gastric ulcer (from the antrum) of a gastrectomy specimen. ... In medicine, stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs. ... Bile (or gall) is a bitter, yellow or green alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... This article or section is in need of attention from an expert on the subject. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes in the females of some animal species that is associated with reproductive fertility. ... Female internal reproductive anatomy The Fallopian tubes, also known as oviducts and uterine tubes, are two very fine tubes leading from the ovaries of female mammals into the uterus. ... Pancreatic juice is a juice produced by the pancreas. ... Pancreatitis is inflammation of the pancreas. ... A dermoid cyst is a teratoma that contains developmentally mature skin, with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, or fat. ... Bodily fluids are fluids, which are generally excreted or secreted from the human body. ... An adhesion is a fibrous band of scar tissue that binds together normally separate anatomical structures. ... An antiseptic is a substance that kills or prevents the growth and reproduction of various microorganisms, including bacteria, fungi, protozoa, and viruses on the external surfaces of the body. ... The word Foreign means originating elsewhere or in the physiological context outside the body. ... For the human abdomen, see human abdomen. ... “Surgeon” redirects here. ... This article does not cite any references or sources. ... For other uses, see Sponge (disambiguation). ... Familial Mediterranean fever (FMF) is a hereditary inflammatory disorder that affects groups of patients originating from around the Mediterranean Sea (hence its name). ... It has been suggested that Acute intermittent porphyria be merged into this article or section. ...

Treatment

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

• General supportive measures such as vigorous intravenous rehydration and correction of electrolyte disturbances.
• Antibiotics are usually administered intravenously, but they may also be infused directly into the peritoneum. The empiric choice of broad-spectrum antibiotics often consist of multiple drugs, and should be targeted against the most likely agents, depending on the cause of peritonitis (see above); once one or more agents are actually isolated, therapy will of course be targeted on them.
• Surgery (laparotomy) is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage which may have caused peritonitis. The exception is spontaneous bacterial peritonitis, which does not benefit from surgery.

An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Rehydration is the pissing of water and electrolytes lost through dehydration. ... Electrolyte disturbance refers to an abnormal change in the levels of electrolytes in the body. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... A broad-spectrum antibiotic is an antibiotic that is affective against many forms of bacteria. ... “Surgeon” redirects here. ... A laparotomy is a surgical maneuver involving an incision through the abdominal wall to gain access into the abdominal cavity. ... In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... Spontaneous bacterial peritonitis is a form of peritonitis that occurs in patients with cirrhosis. ... “Surgeon” redirects here. ...

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. A benign gastric ulcer (from the antrum) of a gastrectomy specimen. ... Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix[1]. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. ... Diverticulitis is a common digestive disorder particularly found in the large intestine. ... Health can be defined negatively, as the absence of illness, functionally as the ability to cope with everyday activities, or positively, as fitness and well-being (Blaxter 1990). ... A patient having his blood pressure taken by a doctor. ... Old age consists of ages nearing the average lifespan of human beings, and thus the end of the human life cycle. ... Illness (sometimes referred to as ill-health) can be defined as a state of poor health. ...

Pathology

The peritoneum normally 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. In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... This page is a candidate to be moved to Wiktionary. ... Turbidity standards of 10, 100, and 1000 NTU Turbidity is a cloudiness or haziness of water (or other liquid) caused by individual particles that are too small to be seen without magnification, thus being much like smoke in air. ... An exudate is any thick fluid that is actively secreted by cells as a result of disease. ... Pus is a whitish-yellow or yellow substance that can be found in regions of bacterial infection, including superficial infections, such as pimples. ... An exudate is any thick fluid that is actively secreted by cells as a result of disease. ... In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... In higher vertebrates, the peritoneum is the membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... In anatomy, the viscera are the internal organs of an animal, in particular the internal organs of the head, thorax and abdomen. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ...

References

• Peritonitis disease causes, treatment ...
• All Refer Health article on peritonitis
• Genuit T and Napolitano L. 2004. Peritonitis and Abdominal Sepsis. Emedicine.com
• Health square. 2004. Peritonitis.