Peritonitis is defined as an inflammation of the serosal membrane that lines the stomach cavity and the organs consisted of therein. Depending on the underlying pathology, the resultant peritonitis might be contagious or sterilized (ie, chemical or mechanical). (See Pathophysiology.).
Peritonitis is most typically triggered by introduction of an infection into the otherwise sterile peritoneal environment through organ perforation, however it might likewise result from other irritants, such as international bodies, bile from a perforated gall bladder or a lacerated liver, or gastric acid from a perforated ulcer. Females also experience localized peritonitis from a contaminated fallopian tube or a ruptured ovarian cyst.
Peritoneal infections are categorized as primary (ie, from hematogenous dissemination, usually in the setting of an immunocompromised state), secondary (ie, related to a pathologic process in a visceral organ, such as perforation or injury, consisting of iatrogenic injury), or tertiary (ie, recurrent or persistent infection after adequate initial therapy). Primary peritonitis is frequently spontaneous bacterial peritonitis (SBP) seen primarily inpatients with chronic liver disease. Secondary peritonitis is by far the most common kind of peritonitis come across in scientific practice. Tertiary peritonitis typically establishes in the absence of the initial visceral organ pathology. (See Clinical Discussion.).
Infections of the peritoneum are more divided into generalized (peritonitis) and localized (intra-abdominal abscess). This short article focuses on the diagnosis and management of contagious peritonitis and stomach abscesses. An abdominal abscess is seen in the image below.
The medical diagnosis of peritonitis is usually clinical. Diagnostic peritoneal lavage may be useful in patients who do not have definitive signs on health examination or who can not supply a sufficient history; in addition, paracentesis must be performed in all clients who do not have an indwelling peritoneal catheter and are suspected of having SBP, because results of anaerobic and aerobic bacterial cultures, used in conjunction with the cell count, are useful in guiding therapy. (See Workup.).
The existing approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or restrict secondary issues due to organ system failure.
Nonoperative interventions consist of percutaneous abscess drain, as well as endoscopic and percutaneous stent positionings. The type and extent of surgery depends on the underlying condition process and the intensity of intra-abdominal infection.