Symptoms often appear suddenly and are
severe. Initially the perforation may provide relief
because it releases pressure but the spreading
infection quickly worsens symptoms. There is
often abdominal rigidity and guarding (extreme
resistance to having anyone touch the abdomen),
ABDOMINAL DISTENTION, high FEVER, and signs of SEP-
TICEMIA(septic SHOCK) such as rapid PULSEand res-
piration. Blood tests and abdominal X-RAY or
ULTRASOUNDgenerally confirm the diagnosis. The
infection paralyzes the intestine, halting PERISTALSIS
and the absorption of fluids, nutrients, and elec-
trolytes. Electrolytes are critically important for
proper regulation of many body activities includ-
ing those of the BRAIN and HEART. Treatment is
immediate intravenous fluids to restore the body’s
electrolyte balance, ANTIBIOTIC MEDICATIONSto begin
fighting the infection, and usually emergency sur-
gery to drain the infection from the peritoneal
cavity and remove any necrotic (dead) tissue or
bowel. Recovery is not certain, and often compli-
cations remain following treatment, depending on
the reason for the peritonitis.
See also PELVIC INFLAMMATORY DISEASE(PID); RENAL
DIALYSIS.
portal hypertension High pressure in the portal
VEIN, the large BLOODvessel that carries blood from
the abdominal organs to the LIVER. CIRRHOSIS, in
which SCARtissue replaces liver tissue as a conse-
quence of repeated INFLAMMATION, is the primary
cause of portal hypertension. Right HEART FAILURE
also can cause portal hypertension.
About 40 percent of the blood that enters the
liver does so through the portal vein. Blood drains
into the portal vein from the digestive organs of
the abdomen, carrying NUTRIENTSand metabolic
wastes to the liver for processing. Though blood
flows through the arteries under high pressure,
the pressure within the veins is low and venous
blood flow mostly relies on a combination of
lower resistance, gravity, and valves within the
veins to prevent backflow.
The spongy tissue of a healthy liver accepts
blood flow from the portal vein in a smooth
process, literally soaking in the blood and chan-
neling it through the thousands of lobules that
form the liver’s interior architecture. The solid
structure of scar tissue does not absorb blood like
the spongy tissue of the healthy liver, and blood
must force its way around. The resistance that
results causes the pressure within the portal vein
to rise.
When scarring becomes severe, as in cirrhosis,
the liver cannot contain the amount of blood
attempting to enter and the blood backs up into
the portal vein as well as the veins that feed into
the portal vein. The walls of the portal vein stiffen
against the resistance, which further raises pres-
sure. Eventually the consequence of portal hyper-
tension is twofold: blood cannot circulate through
the liver and the supporting veins that feed into
the portal vein distend and weaken. These VARI-
COSE VEINStypically protrude into the ESOPHAGUS
(ESOPHAGEAL VARICES) and often bleed.Symptoms and Diagnostic Path
The key symptoms suggesting portal hypertension
are those of liver disease and may include- JAUNDICE, a yellowish discoloration of the SKIN
- PRURITUS(widespread itching)
- fatigue and weakness
- ASCITES, an accumulation fluid in the abdomen
- evidence of GASTROINTESTINAL BLEEDING, which
may appear as VOMITINGblood (hematemesis) or
passing dark stools (melena)
The doctor’s examination can usually detect
numerous signs of portal hypertension, such as
abnormal PULSE, low systemic BLOOD PRESSURE
(HYPOTENSION), and evidence of altered venous
blood flow in the abdomen and lower extremities.
The diagnostic path includes imaging procedures
that can show the flow of blood through the liver,
such as Doppler ULTRASOUND, COMPUTED TOMOGRAPHY
(CT) SCAN, or MAGNETIC RESONANCE IMAGING(MRI).
Endoscopic examination of the esophagus reveals
esophageal varices, a conclusive sign of portal
hypertension.Treatment Options and Outlook
Bleeding esophageal varices require immediate
medical attention. The gastroenterologist often
can cauterize these during ENDOSCOPY. Vasodilator
medications that relax the blood vessels, such as
nitrates and beta blockers, relieve mild to moder-
ate portal hypertension. Moderate to severe portalportal hypertension 83