Description, Causes and Risk Factors:
Diaphragmatic peritonitis is an acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the visceral organs. Peritonitis commonly decreases intestinal motility and causes intestinal distention with gas. Mortality is 10%, with death usually resulting from bowel obstruction: the mortality rate was much higher before the introduction of antibiotics.
Although the GI tract normally contains bacteria, the peritoneum is sterile. In peritonitis, however, bacteria invade the peritoneum. Generally, such infection results from inflammation and perforation of the GI tract, allowing bacterial invasion. Usually, this results from appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, strangulated obstruction, abdominal neoplasm, or a penetrating wound. Other possible reasons for perforation include abdominal trauma, ingestion of a sharp foreign body, perforation by an endoscope or catheter, and anastomotic leakage.
Peritonitis may also result from chemical inflammation, as in rupture of the fallopian tube or the bladder; perforation of a gastric ulcer; or released pancreatic enzymes.
In both chemical and bacterial inflammation, accumulated fluids containing protein and electrolytes make the transparent peritoneum opaque, red, inflamed, and edematous. Because the peritoneal cavity is so resistant to contamination, such infection is often localized as an abscess instead of disseminated as a generalized infection.
The other causes of peritonitis are cirrhosis, which is where the liver becomes scarred.
Liver damage caused by the viral infection hepatitis C.
Being obese (fat molecules can damage the liver's tissue in much the same way as alcohol).
Liver damage caused by persistent alcohol misuse.
People with kidney failure who are having a treatment known as peritoneal dialysis are at risk of developing peritonitis.
Factors that can increase the risk of peritonitis in people who having peritoneal dialysis include:
Having another long-term health condition, such as type 2 diabetes or high blood pressure.
Being elderly (the older you are, the higher your risk of developing peritonitis).
Being overweight or obese.
These are quickly followed by abdominal pain, which usually begins as a dull ache before progressing to a steady, severe pain.
Other symptoms of peritonitis include:
A high temperature (fever) of 38C (100.4F) or above.
Not passing any urine or passing less than normal.
Swelling of the abdomen.
A diagnosis of peritonitis is based primarily on the clinical manifestations.
Leukocytosis, hypokalemia, hypernatremia and acidosis may be present, but they are not specific findings.
Abdominal X-rays may reveal dilated, edematous intestines, although such X-rays are mainly useful to look for pneumoperitoneum, an indicator of gastrointestinal perforation. Abdominal X-rays showing edematous and gaseous distention of the small and large bowel support the diagnosis. In the case of perforation of a visceral organ, the X-ray shows air in the abdominal cavity.
Other appropriate tests include:
Computed tomography (CT or CAT scanning) may be useful in differentiating causes of abdominal pain.
Chest X-ray - may show elevation of the diaphragm.
Blood studies - shows leukocytosis (more than 20,000/ul).
Paracentesis-reveals bacteria, exudate, blood, pus, or urine.
Laparotomy - may be necessary to identify the underlying cause.
Other conditions to consider are acute appendicitis, pancreatitis, cholecystitis, and pelvic inflammatory disease.
Early treatment of GI inflammatory conditions and preoperative and postoperative antibiotic therapy help prevent diaphragmatic peritonitis.
Empiric antibiotic therapy usually includes administration of cefoxitin with an amino glycoside or penicillin G and clindamycin with an aminoglycoside, depending on the infecting organisms. To decrease peristalsis and prevent perforation, the patient should receive nothing by mouth; I.V. fluids are administered. Other supportive measures include preoperative and postoperative administration of analgesia and nasogastric (NG) decompression.
When diaphragmatic peritonitis results from perforation, surgery is necessary. The aim of surgery is to eliminate the source of infection by evacuating the spilled contents and repairing any organ perforation.
Laparotomy is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage which may have caused peritonitis. The exception is spontaneous bacterial peritonitis, which does not always benefit from surgery and may be treated with antibiotics in the first instance.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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