Editing Peritonitis (section)

==Signs and symptoms==
===Abdominal pain===
The main manifestations of peritonitis are acute [[abdominal pain]], [[abdominal tenderness]], [[abdominal guarding]], rigidity, which are exacerbated by moving the [[peritoneum]], e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the [[Blumberg's sign]] (meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place). Rigidity is highly [[Specificity (statistics)|specific]] for diagnosing peritonitis (specificity: 76–100%).<ref>{{Cite book|title=Evidence-based physical diagnosis|last=McGee|first=Steven R.|publisher=Elsevier|year=2018|isbn=9780323508711|edition=4th|location=Philadelphia, PA|chapter=Abdominal Pain and Tenderness|oclc=959371826}}</ref> The presence of these signs in a person is sometimes referred to as peritonism.<ref name="titleBiology Online's definition of peritonism">{{cite web |url=http://www.biology-online.org/dictionary/Peritonism |title=Biology Online's definition of peritonism |access-date=2008-08-14 |archive-date=2018-06-12 |archive-url=https://web.archive.org/web/20180612162253/https://www.biology-online.org/dictionary/Peritonism |url-status=live }}</ref> The localization of these manifestations depends on whether peritonitis is localized (e.g., [[appendicitis]] or [[diverticulitis]] before perforation), or generalized to the whole [[abdomen]]. In either case, pain typically starts as a generalized abdominal pain (with involvement of poorly localizing [[General visceral afferent fibers|visceral innervation]] of the [[Visceral peritoneum|visceral peritoneal layer]]), and may become localized later (with involvement of the [[General somatic afferent fibers|somatic innervation]] of the parietal peritoneal layer). Peritonitis is an example of an [[acute abdomen]].<ref>{{Cite journal |last1=Okamoto |first1=Koh |last2=Hatakeyama |first2=Shuji |date=2018-09-20 |title=Tuberculous Peritonitis |url=http://www.nejm.org/doi/10.1056/NEJMicm1713168 |journal=New England Journal of Medicine |language=en |volume=379 |issue=12 |pages=e20 |doi=10.1056/NEJMicm1713168 |pmid=30231225 |s2cid=205088395 |issn=0028-4793|url-access=subscription }}</ref>

===Other symptoms===
* Diffuse abdominal rigidity ([[abdominal guarding]]) is often present, especially in generalized peritonitis
* Fever
* [[Sinus tachycardia]]
* Development of [[ileus|ileus paralyticus]] (i.e., intestinal paralysis), which also causes [[nausea]], [[vomiting]] and [[bloating]]
* Reduced or no passage of abdominal gas and bowel sound<ref>{{Cite journal |last1=Ragetly |first1=G. R. |last2=Bennett |first2=R. A. |last3=Ragetly |first3=C. A. |date=2012 |title=Therapie und Prognose der septischen Peritonitis |url=http://dx.doi.org/10.1055/s-0038-1623666 |journal=Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere |volume=40 |issue=5 |pages=372–378 |doi=10.1055/s-0038-1623666 |s2cid=73133175 |issn=1434-1239|url-access=subscription }}</ref>

===Complications===
* Sequestration of fluid and [[electrolyte]]s, as revealed by decreased [[central venous pressure]], may cause [[electrolyte disturbance]]s, as well as significant [[hypovolemia]], possibly leading to [[Shock (circulatory)|shock]] and [[acute kidney failure]].
* A [[abscess|peritoneal abscess]] may form (e.g., above or below the [[liver]], or in the [[lesser omentum]])
* [[Sepsis]] may develop, so [[blood cultures]] should be obtained.
* Complicated peritonitis typically involves multiple organs.