Peritonitis and Abdominal Abscess
•Peritonitis is inflammation of the peritoneum.
•Mortality from this condition is unacceptably high, even with the use of potent
antibiotics and surgical intervention.
Classification of Peritonitis
1. Etiology
A. Chemical peritonitis-liquid in the peritoneal cavity-no pathological germs
-later-microbial contamination
B. Septical(microbial) peritonitis
C. Fungic peritonitis
D. Viral peritonitis
2. Pathogenic (way of inoculation)
A. Primary peritonitis-typically streptococcal with probable portal of entry via blood
stream rather than intraabdominal organs
B. Secondary peritonitis-intraperitoneal pathological process or consequence of a
perforating wound
C. Tertiary peritonitis-special group of peritonitis in their evolution-although the
abdominal septic focus is drained,the sistemic septic phenomenons develop→
•MSOF
The most common form isacute bacterial peritonitis!
Acute Bacterial Peritonitis
1
, Causative Organisms
–These are almost always polymicrobial —that is, aerobic and anaerobic bacteria —that
migrate from the gut.
–The most common organisms are Escherichia coli and Bacteroides spp, less commonly
Clostridium welchii.
–In young women, peritonitis can occur by spread of organisms such as gonococci and
streptococci through the Fallopian tubes.
Causes
•acute perforated appendicitis
•acute perforated diverticular disease
•upper GI perforation
•perforated tumors
•iatrogenic manoeuvres
•perforated ischaemic bowel,e.g.due to adhesions
•acute pancreatitis (usually inflammatory rather than infective)
•peritoneal dialysis related: often atypical or cutaneous organisms gaining entry via
contaminated dialysate bags or catheter
•postsurgical intervention,e.g. anastomotic leak,enteric injury
Note= write down the mechanisms of peritonitis from the pictures in the lecture
Pathophysiology
•The peritoneum is a smooth, lubricated surface that allows movement of the intestine.
•It also safeguards the integrity of the abdominal organs.
2
•Peritonitis is inflammation of the peritoneum.
•Mortality from this condition is unacceptably high, even with the use of potent
antibiotics and surgical intervention.
Classification of Peritonitis
1. Etiology
A. Chemical peritonitis-liquid in the peritoneal cavity-no pathological germs
-later-microbial contamination
B. Septical(microbial) peritonitis
C. Fungic peritonitis
D. Viral peritonitis
2. Pathogenic (way of inoculation)
A. Primary peritonitis-typically streptococcal with probable portal of entry via blood
stream rather than intraabdominal organs
B. Secondary peritonitis-intraperitoneal pathological process or consequence of a
perforating wound
C. Tertiary peritonitis-special group of peritonitis in their evolution-although the
abdominal septic focus is drained,the sistemic septic phenomenons develop→
•MSOF
The most common form isacute bacterial peritonitis!
Acute Bacterial Peritonitis
1
, Causative Organisms
–These are almost always polymicrobial —that is, aerobic and anaerobic bacteria —that
migrate from the gut.
–The most common organisms are Escherichia coli and Bacteroides spp, less commonly
Clostridium welchii.
–In young women, peritonitis can occur by spread of organisms such as gonococci and
streptococci through the Fallopian tubes.
Causes
•acute perforated appendicitis
•acute perforated diverticular disease
•upper GI perforation
•perforated tumors
•iatrogenic manoeuvres
•perforated ischaemic bowel,e.g.due to adhesions
•acute pancreatitis (usually inflammatory rather than infective)
•peritoneal dialysis related: often atypical or cutaneous organisms gaining entry via
contaminated dialysate bags or catheter
•postsurgical intervention,e.g. anastomotic leak,enteric injury
Note= write down the mechanisms of peritonitis from the pictures in the lecture
Pathophysiology
•The peritoneum is a smooth, lubricated surface that allows movement of the intestine.
•It also safeguards the integrity of the abdominal organs.
2
