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Definition

The inflammation of the peritoneum or covering of abdominal viscera.
Peritonitis is an irritation of the peritoneum, the tissue that lines the inward mass of the mid-region and covers and supports a large portion of the abdominal organs. Peritonitis is generally brought about by disease from microscopic organisms or parasites.
If we do not care about it, it turns into damage and forms peritonitis, which may be life-threatening and painful.


Peritonitis
About Peritoneal cavity

The peritoneal cavity is a potential space characterized by the viscera, dividers of the abdomen and pelvic cavities, and abdominal organs. A solitary layer of parietal peritoneum lines the abdominal divider, the abdomen, the ventral surface of the retroperitoneal viscera, and the pelvis. It also separates the diaphragm from the abdominal viscera. This covering is lined by cuboidal mesothelial cells which is made by fibrous connective tissue.


Causation

Infection from without
  1. Wounds
  2. Infection of laparotomy

Infection from bloodstream
  1. Streptococcal
  2. Staphylococcal
  3. Pneumococcal
  4. Gram is E. Coli
  5. Rupture of appendix
  6. Perforated peptic ulcer
  7. Inflamed diverticulum
  8. Ruptured intestines
  9. Acute cholecystitis

From female genital tract
  1. Acute salpingitis
  2. Puerperal infections


Signs / Symptoms
  1. Abdominal Pain: Initially colicky, constant and agonizing later on, worse by least movement
  2. Tenderness
  3. Muscular rigidity in relation to the area of peritoneum involved
  4. Paralytic ileus: Distension and absent bowel sounds
  5. The patient is totally immobile
  6. Constipation, vomiting, and fever


Types
  1. Primary peritonitis: Usually in small girls, often pneumococcal infection invading from the genital tract
  2. Tuberculous peritonitis: Arises from tubercular focus in abdomens Such as mesenteric gland or intestinal tuberculosis
  3. Ascetic type and plastic-type
  4. There is an outpouring of protein-rich fluid in the peritoneum. Fever, tachycardia, lassitude, and general wasting with the gradual enlarging abdomen
  5. Tubercle bacilli can be isolated from the peritoneal fluid

On examination
  1. Shifting dullness, fluid thrill in ascetic type, and doughy feeling on palpation in plastic-type are diagnostic.
  2. Malignant type: Fluid protein-rich and of higher specific gravity. Malignant cells detected in a fluid are diagnostic. Stomach and ovary growths and most common to involve the peritoneum.
  3. Symptoms of ascites and parent tumors are presented.
  4. Gonococcal peritonitis: Though rare but common in females from diseases of fallopian tunes and a result of epididymitis in males.


What is Peritoneal fluid?

The covering of the abdominal viscera is called Peritoneum. The peritoneal fluid is a serous fluid that lubricates the abdominal organs and protects them from friction among the organs in the abdomen. When the disease occurs and affects the peritoneum, causes Ascites or fluid in the abdomen, shows like potbelly.



Bacterial Peritonitis

It is a condition, when peritonitis occurs due to bacteria, such as Streptococci, Staphylococci, E. Coli, etc. It is not from outside, rather comes when Ascites occur in disease, which means an increased volume of peritoneal fluid from disease.



Peritoneal Carcinoma

It is a rare disease for the Peritoneum because Peritoneum is a thin covering of the viscera and keeps lubricant the abdominal organs and protects from the abdominal wall as well.

There are two types of Peritoneal cancer
  1. Primacy
  2. Secondary

Primary

  1. The primary peritoneal disease begins and creates in the peritoneum. It normally just influences ladies and once in a while influences men. 
  2. The primary peritoneal disease is firmly identified with epithelial ovarian malignancy. Both are dealt with in a similar way and have a comparative standpoint. 
  3. An uncommon sort of essential peritoneal disease is peritoneal threatening mesothelioma. 

Secondary

The secondary peritoneal disease typically begins in another organ in the midsection and afterward spreads (metastasizes) to the peritoneum. 

Optional peritoneal malignant growth can begin in the: 
  1. Ovaries 
  2. Fallopian tubes 
  3. Bladder 
  4. Stomach 
  5. Colon 
  6. Rectum 

Auxiliary peritoneal malignant growth can influence the two people. It's more normal than the primary peritoneal disease. 

Specialists believe somewhere in the range of 15 and 20 percent of individuals with colorectal malignant growth will foster metastases in the peritoneum. Around 15 to 20 percent of individuals with stomach malignancy will foster metastases in the peritoneum. 

At the point when the malignant growth metastasizes from its unique site, the new site will have a similar kind of disease cells as the underlying site.


Peritoneal Cyst

Peritoneal cyst actually the ovarian cyst in females in reproductive life. The ovarian cyst filled with serous fluid, when it burst in the peritoneal cavity, can cause infection and pain, the result is peritonitis.



Investigation / Peritoneal fluid analysis
  1. Ascetic fluid aspiration- Culture and cell count. If protein is more than 1g /dl, then spontaneous bacterial peritonitis can be ruled out.
  2. In cell count presence of neutrophils more than >250/micro litter, suggests bacterial peritonitis.
  3. Milk color (chylous)- Tuberculosis peritoneum, Lymphoma, Malignancy, or Cirrhosis of the liver.
  4. Turbid color- Bacterial infection, Appendicitis, Pancreatitis, etc.
  5. Bloody- Hemorrhagic inflammation or perforation or benign or malignant tumor



Treatment
  1. Surgical in all cases requiring repair, such as burst appendix, Perforated ulcer.
  2. Paralytic ileus is treated by intestinal decompression and maintained electrolyte balance.
  3. Paracentesis gives symptomatic relief.


Homeopathic medicines

Except for purely surgical cases
Chronic: Lycopodium
Tubercular: Cinchona, Tuberculinum

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