Describe the clinical features and diagnostic workup of a suspected case of peritonitis.
Peritonitis is inflammation of the peritoneum, most commonly due to bacterial infection from visceral perforation. Clinically, patients present with acute, severe, generalized abdominal pain, often worsened by movement. Diffuse tenderness, rebound tenderness, and involuntary abdominal rigidity (guarding) are classical signs. Other features include fever, chills, nausea, vomiting, tachycardia, hypotension, absent bowel sounds, abdominal distension, and in severe cases, signs of sepsis such as altered consciousness or oliguria.
The diagnostic workup begins with a detailed history and thorough physical examination. Laboratory tests include complete blood count (leukocytosis with left shift), inflammatory markers (CRP, procalcitonin), renal and liver function tests, electrolytes, and blood cultures. Urinalysis helps rule out urinary tract infections. Imaging includes plain abdominal X-ray (free air, dilated loops), ultrasound (free fluid, abscess), and contrast-enhanced CT scan of the abdomen and pelvis, which is the gold standard for detecting fluid collections, inflammatory changes, and underlying causes. In select cases, diagnostic paracentesis or peritoneal lavage can be performed for fluid analysis, including cell count, Gram stain, and culture.
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