Definition Peritonitis is an inflammation of the peritoneum, which is the thin layer of tissue that lines the abdominal cavity.
Classification Types of peritonitis:
- Primary peritonitis: Spontaneous bacterial peritonitis, where bacteria enter the peritoneum through the bloodstream.
- Secondary peritonitis: Bacterial infection of the peritoneum secondary to a perforated viscus (e.g., intestine, stomach).
- Tertiary peritonitis: Recurrent or persistent peritonitis, often due to a complication of a previous episode.
Pathophysiology
- Infection of the peritoneum by bacteria, leading to inflammation and release of chemical mediators.
- Release of histamine and other chemical mediators, causing vasodilation and increased vascular permeability.
- Increased fluid and protein loss into the abdominal cavity, leading to ascites (fluid accumulation).
Clinical Features
- Abdominal pain: Severe, diffuse, or localized pain in the abdomen, often worse with movement.
- Tenderness: Tenderness to palpation, which may be localized or diffuse.
- Guarding: Muscle tension in the abdominal wall, which may be absent in early stages.
- Fever: Elevated body temperature, often accompanied by chills.
- Tachycardia: Increased heart rate, often due to sepsis or dehydration.
Diagnostic Investigations
- Complete Blood Count (CBC): To check for signs of infection, inflammation, or sepsis.
- Serum lactate: To assess for tissue hypoxia or metabolic acidosis.
- Blood cultures: To identify the causative organism.
- X-ray: To detect free air under the diaphragm or other signs of bowel perforation.
- Ultrasound: To assess for ascites, bowel obstruction, or other complications.
- CT scan: To evaluate for complications such as abscesses or bowel necrosis.
Paracentesis and Ascitic Fluid Analysis
- Paracentesis: A procedure to drain fluid from the abdominal cavity.
- Ascitic fluid analysis: To evaluate the fluid for signs of infection, inflammation, or other complications.
Surgical Management
- Laparotomy: An emergency surgical procedure to explore the abdominal cavity and control bleeding or infection.
- Source control: To identify and control the source of infection, often by removing a perforated viscus or draining an abscess.
Complications
- Sepsis: A life-threatening condition caused by uncontrolled infection.
- Abscess formation: A localized collection of pus, often requiring drainage or surgical intervention.
- Multi-organ failure: A condition where multiple organs fail due to severe infection or inflammation.
Homoeopathic Therapeutics
- Belladonna: For peritonitis with acute onset, high fever, and severe abdominal pain.
- Arsenicum album: For peritonitis with severe abdominal pain, diarrhea, and vomiting.
- Carbo vegetabilis: For peritonitis with bloating, flatulence, and abdominal discomfort.
- Phosphorus: For peritonitis with severe abdominal pain, diarrhea, and vomiting.
- Gelsemium: For peritonitis with weakness, fatigue, and abdominal discomfort.