PERITONITIS Tammy McDaniel & Emily Stevens Evaluation of Athletic Injuries I AH 322 September 29, 2003

Peritonitis (pear-ih-tuh-NYE-tis) Infection, or rarely some other type of inflammation, of the peritoneum. Peritoneum is a membrane that covers the surface of both the organs that lie in the abdominal cavity and the inner surface of the abdominal cavity itself.

Intra-abdominal infections result in 2 major clinical manifestations Early or diffuse infection results in localized or generalized peritonitis. Late and localized infections produces an intra- abdominal abscess.

2 Major Types Primary: Caused by the spread of an infection from the blood & lymph nodes to the peritoneum. Very rare < 1% Usually occurs in people who have an accumulation of fluid in their abdomens (ascites). The fluid that accumulates creates a good environment for the growth of bacteria.

Secondary: Caused by the entry of bacteria or enzymes into the peritoneum from the gastrointestinal or biliary tract. This can be caused due to an ulcer eating its way through stomach wall or intestine when there is a rupture of the appendix or a ruptured diverticulum. Also, it can occur due to an intestine to burst or injury to an internal organ which bleeds into the internal cavity. 2nd Type:

Both cases are very serious & can be life threatening if not treated properly!!!

Hollow organs are more susceptible to athletic injury when they are full of waste & food products. Injury to a hollow organ may so signs of: > black tarry stool >bright red blood in the fecal discharge >bloody vomitus * Always remember there may be referred pain.

Signs & Symptoms Swelling & tenderness in the abdomen Fever & Chills Loss of Appetite Nausea & Vomiting ^ Breathing & Heart Rates Shallow Breaths Low BP Limited Urine Production Inability to pass gas or feces

Symptoms Cont: An acutely ill patient tends to lie very still because any movement causes excruciating pain. They will lie with there knees bent to decrease strain on the tender peritoneum.

Exam & Evaluation Feel & press the abdomen to detect any swelling & tenderness in the area as well as signs of fluid has collected in the area. Listen to the bowel sounds & check for difficulty breathing, low blood pressure & signs of dehydration.

Evaluation cont: The usual sounds made by the active intestine and heard during examination with a stethoscope will be absent, because the intestine usually stops functioning. The abdom may be rigid and boardlike Accumulations of fluid will be notable in primary due to ascites.

Exams cont: Blood Test Samples of fluid from the abdomen CT Scan Chest X-rays Peritoneal lavage.

Treatment Approach Hospitalization is common. Surgery is often necessary to remove the source of infection. Antibiotics are prescribed to control the infection & intravenous therapy (IV) is used to restore hydration.

TX Cont: Morphine for pain. Dietary supplements (omega 3, omega 6 fatty acids, vitamin A, E, C, and zinc)

Prognosis Untreated peritonitis is poor, usually resulting in death. With Tx, prognosis is variable, dependent on the underlying causes.

Preventive Care There is NO WAY to prevent peritonitis, since the diseases it accompanies are usually not under the voluntary control of an individual. However, the best way to prevent serious complications is to seek medical attention as soon as symptoms appear.

Histopathology of typical flask-shaped ulcer of intestine

This occurs in acute pancreatitis

References: Evaluation and Management of Secondary Peritonitis. American Family Physician 54 (October 1996): Subacute Bacterial Peritonitis: Diagnosis and Treatment. American Family Physician 52 (August 1995): 645. Isselbacher, Kurt J., and Alan Epstein. Diverticular, Vascular, and Other Disorders of the Intestinal and Peritoneum. In Harrisons Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

References cont: Platell C., Papadimitiriou J M., Hall J.C. The Influence of Lavage Fluid on Peritonitis. Journal of American College Surg 2000; 191: Boeschoten, EW. Long-Term Consequences of Peritonitis. Perit Dial Int. 1996;16(suppl 1): S349-S354.