- Acute peritoneal inflammation is most often secondary to a
disease condition of the abdominal viscera or contamination of
the peritoneal cavity through a penetrating wound.
- Many conditions can lead to peritonitis and are:
* Perforation of peptic ulcer
* Acute inflammation of the vermiform appendix
* Gangrene of the bowel
* Acute inflammation of the gallbladder
* Post-operative intestinal leak into the peritoneal cavity
* Infection along the fallopian tubes in a young female
* Septicaemia
3.2 CLINICAL PICTURE
The most prominent feature of peritonitis is:
- Pain in abdomen. It starts from the time of contamination and
it is a diffuse generalised continued burning pain in the
abdomen.
- Intestinal activity comes to a stand still and distension of
the abdomen is observed.
- Patient also shows signs of dehydration due to starvation the
intestines, vomiting fluid loss into the peritoneal cavity and
submesothelial oedema.
- The inflammatory response is very severe in cases of colonic
perforation when compared with small bowel's perforation
because of high bacterial content in the colon.
- The patient gives the appearance of toxaemia.
Local examination of the abdomen shows a tense tender abdomen
with a certain degree of guadrding and later rigidity of the
abdominal muscles.
Respiratory movement is rapid and the abdomen is held immobile.
Loss of fluid and electrolytes into the peritoneal cavity
produces hypovolaemia and shock. There may also be evidence of
septicaemia.
If untreated, the shock like state can produce renal shut down
Fig.FC.1.
Other signs consist of raised temperature 40-42oC and a rapid
thready pulse.
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