CLINACASE

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ID: 226
Category: Stomach
CreatedBy: 1
UpdatedBy: 1
createdon: 30 Mar 2023
updatedon: 17 Apr 2023

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Author: Khoa Tran
Published Mar 30, 2023
Updated Apr 17, 2023

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Peritonitis

Etymology and Pronunciation

peritonitis (peh-rih-tuh-NAHY-tis)
peri - Greek for "around"
tonos - Greek for "tension"
-itis - Greek for "inflammation"

History of Peritonitis

Peritonitis is an inflammation of the peritoneum which is the membrane lining the abdominal cavity and covering the abdominal organs. It usually occurs due to bacterial infection, injury or as a complication of surgery.

The Greek physician Hippocrates, who is considered the father of modern medicine, described peritonitis as a complication of abdominal surgery. He described it as 'painful abdomen' and 'fever'. The condition was also mentioned in the works of Galen, a physician who lived in the second century AD.

In the 19th century, the French surgeon Jules Péan was the first to describe the condition as a result of perforation of the stomach or intestine. However, it was not until the late 1800s that peritonitis was recognized as a distinct clinical entity.

In 1847, Ignaz Semmelweis, a Hungarian physician, discovered the cause of peritonitis was the result of infections caused by the lack of handwashing and proper hygiene practices. This was before the discovery of bacteria, but Semmelweis was able to observe that mortality rates decreased when doctors and nurses washed their hands with disinfectants before performing surgery. 

In 1885, the American surgeon William Halsted published a paper on the treatment of peritonitis, in which he described the use of surgical drainage and irrigation to treat the condition. Halsted's work was a major breakthrough in the treatment of peritonitis, and his techniques became the standard of care for many years.

In the early 20th century, advances in surgical techniques and anesthesia led to further improvements in the treatment of peritonitis.

It was not until the development of antibiotics in the 1940s that the condition became more manageable. Antibiotics are now widely used to treat bacterial infections that can cause peritonitis.

Modern Understanding of Peritonitis

Peritonitis is a medical condition where there is inflammation of the peritoneum, which is a thin layer of tissue that lines the inside of the abdomen and covers the organs inside. It can be caused by infection, injury, or inflammation in the abdomen. Peritonitis can lead to serious complications, including sepsis and organ failure, and requires immediate medical attention.

Causes of Peritonitis

- Bacterial infection: Bacteria can enter the peritoneal cavity through a perforation in the gastrointestinal tract, such as a perforated ulcer or ruptured appendix, or through a surgical incision. Common bacteria that cause peritonitis include Escherichia coli, Klebsiella, and Streptococcus.
- Fungal infection: Fungal peritonitis can occur in people with weakened immune systems, such as those with HIV/AIDS, cancer, or who are receiving immunosuppressive therapy.
- Chemical irritation: Irritants such as bile or stomach acid can leak into the peritoneal cavity due to a perforation in the gastrointestinal tract or following surgery, causing inflammation and peritonitis.
- Trauma: Physical trauma, such as a blow to the abdomen or a penetrating injury, can cause peritonitis.
- Foreign objects: Foreign objects, such as surgical sponges or broken catheter tips, left inside the abdomen after surgery can lead to infection and inflammation.
- Inflammatory bowel disease: Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis can cause inflammation and ulceration of the intestines, which can lead to perforation and peritonitis.
- Dialysis: Peritonitis can occur in people receiving peritoneal dialysis, a type of dialysis that uses the peritoneum as a filter to remove waste products from the blood. Bacteria can enter the peritoneal cavity through the dialysis catheter and cause infection.
- Cirrhosis: In people with liver cirrhosis, the accumulation of fluid in the abdominal cavity (ascites) can become infected and lead to peritonitis.

Treatments for Peritonitis

The treatment of peritonitis depends on the severity and the underlying cause of the condition. Treatment typically involves hospitalization, supportive care, and surgical intervention.

In severe cases of peritonitis, hospitalization is necessary for the administration of intravenous antibiotics and other medications to help control the infection. These medications may need to be adjusted based on the results of culture and sensitivity testing to determine the specific bacterial or fungal pathogen causing the infection.

Supportive care measures may also be necessary to help manage symptoms and complications associated with peritonitis. For example, patients may require intravenous fluids and electrolytes to help maintain fluid and electrolyte balance and prevent dehydration.

Surgical intervention may be necessary to remove any infected tissue or debris from the peritoneal cavity, repair any perforations or tears in the gastrointestinal tract, and address any underlying causes of the condition, such as appendicitis, diverticulitis, or pancreatitis.

In some cases, peritonitis may result in the formation of abscesses within the peritoneal cavity, which may require drainage via percutaneous catheter or open surgical drainage.

Overall, the treatment of peritonitis is complex and often requires a multidisciplinary approach involving physicians, surgeons, and other healthcare providers to ensure that patients receive optimal care and management of the condition.

Symptoms

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Severe belly pain that gets worse with any motion
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Low blood pressure and shock
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Sore or swollen belly
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Thirst
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Confusion
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Reduced urine
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Trouble breathing
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Rigid abdominal muscles
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Abdominal pain
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Constipation
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Diarrhea
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Fever
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Fatigue
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Loss of appetite
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Nausea
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Vomiting
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Bloating

Confirmation Tests

- Blood test
- X-rays
- CT scan
- Peritoneal fluid analysis

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