Medical history (history of illness) is an important component in the diagnosis of peritonitis (inflammation of the peritoneum). Family history What is the general health of your family members? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). Are you experiencing pain? If yes, when does the pain occur? Where … Peritonitis: Medical History
Acute abdomen of other cause (see differential diagnoses under “Acute abdomen” Pseudoperitonitis diabetica – in diabetic patients with onset of ketoacidotic coma, the symptomatology may be similar to that of peritonitis
The following are the most important diseases or complications that may be contributed to by peritonitis (inflammation of the peritoneum): Infectious and parasitic diseases (A00-B99). Sepsis, septic shock Mouth, esophagus (food pipe), stomach and intestines (K00-K67; K90-K93). Intraabdominal abscesses (collections of pus). Intraabdominal adhesions (adhesions). Further Multi-organ failure (MODS, Multi organ dysfunction syndrome; MOF: Multi … Peritonitis: Complications
Classification of peritonitis by stage. Stage Description I Diffuse purulent peritonitis; no organ involvement II Purulent peritonitis with involvement of an organ (renal failure, respiratory insufficiency/disruption of external (mechanical) respiration leading to abnormally altered blood gases, etc.). III Purulent peritonitis with involvement of ≥ 2 organs
Pathogenesis (development of disease) Primary peritonitis (1% of peritonitis) occurs without identifiable infection. It usually develops from ascites. The exact cause is still unclear, but hematogenous pathogen seeding (streptococci, pneumococci) is thought to be involved. In this case, ascites represents an ideal culture medium. In secondary peritonitis, bacterial seeding (usually by bacteria from the intestine) … Peritonitis: Causes
Therapy for peritonitis (inflammation of the peritoneum) is based on the cause. Depending on the symptomatology, intensive medical therapy may be required. General measures Antibiotic therapy and infusion therapy (for fluid replacement) are given for primary peritonitis. In secondary peritonitis, a combination of surgical intervention to eliminate the cause (surgical revision with irrigation and sanitation … Peritonitis: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? … Peritonitis: Examination
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar) Blood gas analysis (BGA) Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin. Renal parameters – urea, creatinine, … Peritonitis: Test and Diagnosis
Therapeutic target Elimination of the pathogens Avoidance of complications Therapy recommendations Antibiosis (antibiotic therapy) for: Secondary peritonitis (e.g., perforation/rupture of an abdominal organ): choice of antibiotics depending on the presence of focal (“focal”) or diffuse peritonitis (inflammation throughout the abdomen). spontaneous-bacterialPeritonitis (SBP; special form of primary peritonitis, which occurs in the context of a therapy-refractory … Peritonitis: Drug Therapy
Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnostics. Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnosis. Electrocardiogram (ECG; recording of the electrical activities of the heart muscle). X-ray of the … Peritonitis: Diagnostic Tests
The following symptoms and complaints may indicate primary peritonitis (inflammation of the peritoneum): Leading symptoms Fever Ascites (abdominal dropsy) – usually occurs before infection. Abdominal pain, occurring acutely Associated symptoms Fatigue Severe feeling of illness Encephalopathy – disease or damage to the brain. The following symptoms and complaints may indicate secondary peritonitis: Acute onset of … Peritonitis: Symptoms, Complaints, Signs
