Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Peritoneal Tumors Peritonitis 1161

■peritoneal carcinomatosis: intraperitoneal chemotherapy advo-

cated by some

■ovarian cancer: surgical debulking and chemotherapy most promis-

ing

follow-up

n/a

complications and prognosis

■overall very poor: survival 70% at 1 month, 25% at 3 months,12% at

6 months, and 4% at 12 months after diagnosis of peritoneal carci-

nomatosis

PERITONITIS

MINDIE H. NGUYEN, MD

history & physical

History

■bacterial peritonitis common in ambulatory peritoneal dialysis (1.4

events per patient-year)

■tuberculous peritonitis: in the US, 50% of the cases are associated

with cirrhosis, usually alcoholic; in third-world countries, most cases

occur without underlying cirrhosis

■Fitz-Hugh-Curtis syndrome=Chlamydia (less commonly gonococ-

cus) peritonitis; actually a perihepatitis; very rare in men

■fungal peritonitis: usually due to Candida albicans and associated

with perforated viscus or ambulatory peritoneal dialysis

■peritoneal histoplasmosis, coccidioidomycosis, and cryptococcal

infection: rare in the US; usually seen in the setting of AIDS

■parasitic peritonitis: schistosomiasis, pinworms, ascariasis, strongy-

loidiasis, amebiasis; rare

■rare causes of peritonitis: connective-tissue diseases (lupus, pol-

yarteritis, and scleroderma); familial Mediterranean fever (very rare

in the US, common in Europe and in the Far East)

Signs and Symptoms

■peritoneal dialysis: abdominal pain and tenderness in 75% but fever

only in 33%

■Fitz-Hugh-Curtis syndrome: RUQ pain, fever, hepatic friction rub;

ascites may not be detectable clinically