Clinical features of generalised peritonitis

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