peritonitis

Japanese: 腹膜炎

Definition/Concept The peritoneum is a thin serous membrane that is broadly divided into the visceral peritoneum, which covers organs such as the intestines, and the parietal peritoneum, which covers the abdominal wall. Inflammation of the peritoneum due to some cause is called peritonitis, and is usually accompanied by the accumulation of ascites.
The causes of the disease include: 1) bacterial (including tuberculosis bacteria), 2) chemical caused by bile or intestinal contents, 3) malignant tumors, 4) autoimmune causes such as vasculitis, and 5) blood flow disorders.
Test results
1) Abdominal images (plain X-ray, CT, ultrasound, etc.):
It is essential to search for the cause in cases of secondary or cancer. It is also useful in evaluating ileus caused by peritonitis. The presence of free air is a finding that suggests intestinal perforation.
2) Characteristics and culture of ascites obtained by abdominal paracentesis (Table 8-10-1):
In primary and secondary cases, polymorphonuclear neutrophils are predominant, in tuberculous cases lymphocytes are predominant, and in cancerous cases cancer cells are detected in the ascites. An increase in neutrophils in the ascites of primary cases is useful in differentiating it from simple ascites caused by liver cirrhosis.
3) Blood test:
In addition to abnormal findings due to the underlying disease, there is an increase in white blood cells and an increase in CRP (C-reactive protein), reflecting inflammation. In severe cases, there may also be a decrease in white blood cells. Be aware of impaired consciousness due to circulatory failure and sudden deterioration of renal function. [Fujisawa Satoshi and Matsuhashi Nobuyuki]
■ References
Debrock G, Vanhentenrijk V, et al: A phase II trial with rosiglitazone in liposarcoma patients. Br J Cancer, 89: 1409-1412, 2003.
Saab S, Hernandez JC, et al: Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis. Am J Gastroenterol, 104: 993, 2009.

Table 8-10-1
Characteristics of Ascites (modified from Tsuneaki Sugimoto et al., Internal Medicine, 8th ed., Asakura Publishing, 2003)

Table 8-10-1

Source : Internal Medicine, 10th Edition About Internal Medicine, 10th Edition Information

Japanese:

定義・概念
　腹膜は薄い漿膜であり腸管などの臓器を覆う臓側腹膜と腹壁を覆う壁側腹膜に大別される．この腹膜に何らかの原因により炎症が引き起こされた状態を腹膜炎とよび，たいていの場合腹水貯留を伴う．
病因
　①細菌性（結核菌を含む），②胆汁・腸管内容物による化学性，③悪性腫瘍，④血管炎などの自己免疫性，⑤血流障害などの因子により生じる．
検査成績
1）腹部画像（単純X線，CT，超音波など）：
続発性，癌性では原因の検索に必須である．また腹膜炎によって生じるイレウスの評価にも有用である．free airの存在は腸管の穿孔を示唆する所見である．
2）腹腔穿刺による腹水の性状，培養など（表8-10-1）：
原発性，続発性では多核好中球が優位に，結核性ではリンパ球が優位に認められ，癌性では癌細胞が腹水中より検出される．原発性で腹水中の好中球の上昇は，肝硬変による単純性腹水貯留との鑑別に有用である．
3）血液検査：
原疾患による異常所見を認めるほか，炎症を反映し白血球の増加，CRP（C反応性蛋白）の上昇をみる．重症例では逆に白血球の低下もありうる．循環不全による意識障害，急激な腎機能の悪化に注意をする．［藤沢聡郎・松橋信行］
■文献
Debrock G, Vanhentenrijk V, et al: A phase II trial with rosiglitazone in liposarcoma patients. Br J Cancer, 89: 1409-1412, 2003.
Saab S, Hernandez JC, et al: Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis. Am J Gastroenterol, 104: 993, 2009.

表8-10-1
腹水の性状（杉本恒明他編：内科学第8 版，朝倉書店，2003 より改変）">

表8-10-1

出典　内科学第10版内科学第10版について　情報

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