Definition and Pathophysiology of Peritonitis
Definition of of Peritonitis
Peritonitis is an inflammation of the serous membrane that surrounds the abdominal cavity and organs located in it. Peritonitis is often caused by infection inflammation surrounding environment through bowel perforation as rupture of the appendix or diverticulum, as originally peritonitis is a sterile environment. It can also be caused by chemical irritants material such perforated ulcer of stomach acid or bile from the gall bladder perforation or laceration of the liver. In women it is possible localized peritonitis in the pelvic cavity of the fallopian tube infection or rupture of ovarian cysts. Cases of acute peritonitis untreated can be fatal.
Pathophysiology of Peritonitis
Initial reaction of peritoneal against invasion by bacteria is the release of fibrinous exudate. Pockets of pus (abscess) formed between fibrinous adhesions, which stick together with the surrounding surface, limiting the infection. Adhesions usually disappears when the infection disappear, but may persist as fibrous bands, which later can lead to intestinal obstruction.
Inflammation causing fluid accumulation, due to capillary and membrane leak. If the fluid deficit is not corrected quickly and aggressively, it can lead to cell death. The release of various mediators, such as interleukin, can initiate hyper-inflamatorius response, thus bringing to the further development of the failure of many organs. Because the body tries to compensate by means of fluid and electrolyte retention by the kidneys, waste products also accumulate. Tachycardia initially increases cardiac output, but it soon failed so happens hypovolemia.
Organs in the peritoneal cavity including experiencing abdominal wall edema. Edema caused by capillary permeability these organs rising. Collection of fluid in the peritoneal cavity and intestinal lumens and all organs of intra peritoneal edema, and edema of the abdominal wall including retroperitoneal tissue causing hypovolemia. Hypovolemia increases with an increase in temperature, the input that does not exist, and vomiting. Trapped fluid in the peritoneal cavity and intestinal lumen, further increasing intra-abdominal pressures, making full respiratory effort becomes difficult and cause a decrease in perfusion.
If the material that infects widespread on peritoneal surface or if the infection spreads, can arise generalized peritonitis. With the development of generalized peritonitis, peristaltic activity is reduced to arise paralytic ileus; intestinal atony and then be stretched. Fluids and electrolytes lost into the intestinal lumen, resulting in dehydration, shock, circulatory disorders and oliguria. Adhesions can form between the arches are stretched intestine, and can interfere with the recovery of bowel movements and cause intestinal obstruction.
Long blockage in the intestine or bowel obstruction can cause ileus due to mechanical disturbance (blockage) then an increase in intestinal peristalsis in an effort to overcome the obstacles. Ileus can be ileus simple, ie, bowel obstruction were not accompanied by pinching of blood vessels and can be total or partial, in the strangulation ileus obstruction, accompanied by pinching of blood vessels, causing ischemia that will end up with necrosis or gangrene and perforation of the intestine and eventually occur due to the spread of bacteria in the abdominal cavity that can occur peritonitis.
