Peritonitis Pathogenesis

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Peritonitis indicates an inflammatory response of the peritoneal layer in the abdominal cavity that arises due to an activation of local mediator cascades by different stimuli. Depending on the pathogenesis, it can be classified into three specific types: primary, secondary or tertiary peritonitis, each representing a distinct clinical entity. Peritoneal mesothelial cells are not inactive cells, but play essential roles in peritoneal homeostasis and synthesize a plethora of cytokines, growth factors, proteases and matrix proteins. Peritonitis causes severe injury to those cells, peritoneal host defense as a whole, as well as the maintenance of the peritoneal membrane structure. In most of the different forms of peritonitis, there is a principal, …show more content…

The Gram-negative aerobic bacteria are the major factor in the development of spontaneous bacterial peritonitis (most notably Escherichia coli and Klebsiella pneumoniae), but Staphylococcus aureus and other Gram-positive bacteria are being considered as emerging agents causing this inflammation. Anaerobes and microaerophilic organisms are still infrequently reported. In prepubescent girls, the pathogenesis of primary peritonitis is often related to an ascending infection of genital origin, as suggested by the simultaneous presence of pneumococci in vaginal secretions and peritoneal fluid. Alkaline vaginal secretions in this age group are less inhibitory to bacterial growth in comparison to the acidic secretions of postpubescent …show more content…

Other described risk factors are serum bilirubin concentration above 2.5 mg/dL, variceal bleeding, and a prior episode of spontaneous bacterial peritonitis. Causes of secondary and tertiary peritonitis Secondary peritonitis arises as a result of an inflammatory process in the peritoneal cavity secondary to inflammation, perforation, or gangrene of an intra-abdominal or retroperitoneal structure. Some of the more common causes include appendicitis, pancreatitis, diverticulitis, acute cholecystitis and perforated peptic ulcer. Other nonbacterial causes of peritonitis include leakage of the blood into the peritoneal cavity due to a rupture of a tubal pregnancy, ovarian cyst or aneurysmal vessel. As blood is highly irritating to the peritoneum, it may cause abdominal pain akin to septic peritonitis. Aseptic peritonitis may also be caused if a sterile foreign body is inadvertently left in the peritoneal cavity after surgery (for example, surgical sponges, instruments or starch from surgical gloves). This condition can also be a complication of certain systemic diseases such as porphyria, systemic lupus erythematosus or familial Mediterranean

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