Acute Peritonitis : Etiology

Name : Vihari Vichakshana RajaguruGroup : No 32

4th year 2nd semester

What’s peritoneum ?

• Made of mesothelium.• Largest cavity in the body • Composed of flattened polyhedral cells,

resting on fibro-elastic membrane.• Beneath the peritoneum lies loos areolar

tissue which has rich supply of capillaries and lymphatics.

Introduction

• Defined as inflammation of the peritoneum.• May be localized or generalized.

• In most cases there is bacterial invasion hence when it is said that there is peritonitis Bacterial peritonitis.

• Even in patients with non bacterial peritonitis like those d/t Pancreatitis Eventually gets infected d/t transmural spread from the gut.

Causes

• Bacterial Gastrointestinal & non- gastrointestinal

• Chemical Bile, Barium• Allergic Starch• Traumatic Operative Handling• Ischaemic Strangulated bowel, vascular

occlusion• Miscellaneous Familial Mediterranean fever.

Routes of spreading

• Bowel perforation

• Transmural Translocation

• Exogenous contamination

• Female genital tract

• Hematogenous spread

Microbiological aspect

• Peritoneal infection is usually caused by more than 2 strains of bacteria.

• Gram negative endotoxins (lipopolysaccharides) TNF

Endotoxic shock Tissue perfusion

• These organisms are present in the lower GI tract and do respond to Penicillins rather to metronidazole and clindamycin and cephalosporins

Non gastrointestinal causes

• Pelvic infection via fallopian tubes are one of the major causes of Non GI cause of peritonitis.

• The most common organisms being Chlamydia or gonococcus.

• Chlamydia Fitz Hugh Curtis Syndrome (perihepatitis)

• Fungal Peritonitis In severely ill patients or Immuno-compramised patients.

Microorganisms• GASTRO INTESTINAL SOURCE:– E.coli– Streptococci– Bacteroids– K.pneumonia

• NON GASTROINTESTINAL SOURCE:– Chlamydia– Neisseria gonorrheoa– Streptococci– Mycobacterium & Fungal

Localized Peritonitis• Anatomical and pathological factors help confining infection to

localized areas.

• Greater sac is divided into– Subphrenic space– The pelvis– Peritoneal cavity proper.

• Supracolic and infracolic (division by transverse colon and transverse mesocolon)

• When supracolic compartment overflows, it does so over to infracolic region/paracolic gutters/pelvis.

Peritoneum•Inflammed peritoneum loses sheen

Fibrin •Flakes of fibrin appear loops of intestine become adherent to each other

Leukocytes •Outpouring of serous fluid rich in leukocytes which later becomes frank pus Ileus Prevents spread of infection Greater omentum seals the area.

Diffuse peritonitis• Factors favoring spread of peritonitis.– Speed of peritoneal contamination– Ingestion of food.– Virulence of infecting organism– Young children with small omentum.– Disruption of localized collection– Immune deficiency

• With appropriate treatment localized disease will resolve– About 20% progress to abscess.

Thank you !