Peritonitis clinical presentation

CLINICAL PRESENTATION OF PERITONEAL DIALYSIS-RELATED PERITONITIS... 

TABLE 112—4. Clinical Presentation of Peritonitis Primary Peritonitis... 

Intraabdominal infections have a wide spectrum of clinical features. Peritonitis usually is easily recognized, but intraabdominal abscess often may continue for long periods of time. Patients with primary and secondary peritonitis present quite differently. 

Drug concentrations in pleural fluid, peritoneal fluid, synovial fluid, aqueous humor, and vitreous humor approach two-thirds of the serum concentration when local inflammation is present. Meningeal and am-niotic fluid penetration, with or without local inflammation, is uniformly poor. Measurement of serum, urine, or cerebrospinal fluid drug levels has not been used clinically. 

Intraabdominal infections have a wide spectrum of clinical features often depending on the specific disease process, the location and the magnitude of bacterial contamination, and concurrent host factors. Patients with primary and secondary peritonitis present quite differently (Table 42-3). If peritonitis continues untreated, the patient may experience hypovolemic shock from fluid loss into the peritoneum, bowel wall, and lumen. This may be accompanied by generalized sepsis. Intraabdominal abscess may pose a diagnostic challenge as the symptoms are neither specific nor dramatic. 

Diverticulosis is usually clinically asymptomatic. About 80-85% of patients with diverticulosis have no symptoms (Cheskin et al. 1990), but it is predisposing for complications such as diverticulitis, perforation, peritonitis, fistulas and even bleeding. For a clear overview presentation of diverticulosis contrast enema has been the diagnostic gold standard for many years. 

The Dapaong tumour, the uninodular form of the disease, presents as a painful ligneous mass of 30-60 mm in the abdominal wall or within the abdominal cavity (Pages et al. 1988). It is usually associated with fever. This can lead to cutaneous abscess and fistula, peritonitis due to rupture of nodule, obstruction of bowel due to adhesion and volvulus. Clinical symptoms are often vague and indeterminate. They mimic a lot of other conditions (Storey et al. 2001). 

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