Peritonitis
Peritonitis is a surgical emergency, characterized by the inflammation of the peritoneum. It manifests clinically by the presence of the “Protective” response, also known as abdominal guarding, and rebound tenderness. The management of peritonitis is based on the underlying cause. Most commonly, bowel perforation is the main cause of peritonitis, but perforation of other organs (gallbladder, appendix) or a perforated ulcer can also cause peritonitis. Bacterial infection is also a cause for peritonitis, and the management includes an explorative laparotomy with lavage of the abdominal cavity with saline and an antibacterial solution. Pre-operatively, patients suspected of peritonitis need broad spectrum antibiotic coverage and fluid resuscitation.
Clinical Signs of Peritonitis
Blumberg’s Response (Rebound Tenderness)
Blumberg’s Sign, also known as Rebound Tenderness, is a clinical sign characterized by an increased intensity of pain upon removal of the pressure over the abdomen.
The examiner applies pressure to the area of the abdomen to be examined watching the patient’s face and asking whether the patient experiences pain. The palpating hand is removed abruptly and the patient is now asked about the pain. A positive sign is that the pain is worse when the hand is removed signifying the presence of an inflamed parietal peritoneum
Classifications of Peritonitis
Microbial contaminant
Primary
Secondary
Clinical course
Acute
Chronic
Etiologic Agents
GI Bacteria
E.coli, S.aureus, streptococcus
Extra GI Bacteria
Gonoccocal, Pneumococcal
Aseptic
Bile
Pancreatic Enzymes
Urine
Chyle
Blood
Character of Exudate
Serous
Fibrinous
Purulent
Hemorrhagic
Putrid
Extent of inflammation
Diffuse
Local
Total