clinical features of generalised peritonitis

Last reviewed 01/2018

The clinical features of generalised peritonitis include:

• patient is systemically very ill - fever, tachycardia, prostration
• postural hypotension - there may be a massive exudation of inflammatory fluid into the peritoneal cavity causing hypovolaemia
• severity of symptoms depends on cause of the peritonitis:
• if there is infection, i.e. faeces, pus, infected bile, then the initial presentation may not be severe initially; eventually, with spread the peritonitis becomes very severe
• with chemical peritonitis, e.g. perforated peptic ulcer, then the initial presentation may be very severe but becomes less so with inflammatory dilution

• on examination:
• rigidity of the abdominal wall
• diffuse abdominal tenderness
• bowel sounds may be absent because of peristaltic paralysis
• if there is severe peritonitis, e.g. faecal, there may be signs of gram-negative bacteraemic shock, i.e. hypotensive, cold patient
• rectal tenderness
• radiographically:
• may be air under the diaphragm if perforated viscus
• the majority of patients will show signs of intestinal ileus