Acute Peritonitis

Acute Peritonitis

    * Introduction
    * Symptoms and Diagnosis
    * Treatment
Peritonitis is an inflammatory reaction of the peritoneum, which may be diffuse or localized infectious origin or not. Most are of infectious peritonitis, the most frequent pathogens were Escherichia coli, enterococci, Klebsiela, Enterobacter, Proteus, Bacteroides. Peritoneal cavity extends from the diaphragm (cranial) to the pelvis (caudal), and the abdominal wall (anterior) to the retroperitoneal viscera (aorta, vena cava, ureters, kidneys). Peritoneum is composed of two layers, one internal (visceral peritoneum) and one external (parietal peritoneum). Most peritonitis (90%) are due to destruction of the gastrointestinal tract (secondary peritonitis) in peritoneal fluid when identifying multiple home enteral germs. A much lower percentage of peritonitis in which it is preserved and the integrity of the gastrointestinal tract occur in the absence of trauma or surgery (primary peritonitis). For the diagnosis of peritonitis are very important history and physical examination. Thus, if the patient has a history of recent hospitalization, chronic illness, recent surgery, fever, chills, pain intensity is increased to raise the suspicion of abdominal peritonitis. Nausea and vomiting are also symptoms and palpation of the abdomen showed significant protection against muscle (abdominal wall contractions that occur during palparii) and muscle contraction (muscle contraction reaching abdomen unprovoked) in acute peritonitis. When acute peritonitis was diagnosed, treatment should be prompt to avoid an unfavorable evolution to sepsis and then exitus (death). Treatment of choice is surgical and consists in removing the source of contamination, contamination reduction, waste treatment and infection prevention of recurrence of infection. Postoperative evolution is favorable if prompt surgical treatment and antibiotic treatment is completed.
Pathogenesis
The appearance of peritonitis usually involves the interaction of three factors: flooding bacterial peritoneal cavity, increased virulence of these pathogens and the means of defense weakening local or general. In primary peritonitis is contamination by marrow during a bacteremia (presence of bacteria in blood), which is usually a single seed and infections occur mainly in children and immunocompromised. Secondary peritonitis are due to lesion of visceral abdominal or digestive tract. Characteristics of germs in secondary peritonitis generally correspond injured body flora. Normal flora of the esophagus, stomach, duodenum and proximal part of the small intestine is low, then begins to increase progressively in the distal intestine, such as colon flora is very rich.