TABLE 10-3.

Characteristics, Causes, and Diagnosis of Chemical Peritonitis

	BILE PERITONITIS	UROABDOMEN	PANCREATITIS	RUPTURED “CYSTS”
Appearance	Golden brown, golden green, serosanguineous, turbid	Light to dark yellow ± serosanguineous, clear (some acute), turbid (chronic)	White, yellow, serosanguineous, turbid	Clear to turbid, pale to yellow, colorless
Causes	Blunt abdominal trauma Necrotizing cholecystitis Cholelithiasis	Trauma: avulsed ureter or bladder, ruptured bladder Neoplasia Urolithiasis	Pancreatitis	Perirenal cysts Polycystic renal/hepatic disease Pancreatic cysts Paraprostatic/prostatic cysts
Clinical features	Vague abdominal pain Lethargy Pale or acholic feces Increased hepatic enzymes Jaundice (chronicity) Septic peritonitis Gallbladder: may be difficult to visualize on ultrasonography	Dehydration Azotemia Anuria/oliguria Abdominal distention Hyponatremia/hyperkalemia Hyperphosphatemia/acidosis	Anorexia Vomiting Abdominal pain Lethargy Fever Jaundice Increased hepatic enzymes Increased lipase/amylase/TLI Increased cholesterol Increased bilirubin Cardiac arrhythmias Pleural effusion Acute renal failure	Vary with underlying tissue involved and severity of lesion
Definitive diagnosis	Free and phagocytized bilirubin crystals Fluid bilirubin greater than serum bilirubin May require ultrasound- directed fluid aspiration or hepatobiliary scintigraphy	Intravenous urogram Retrograde ureterocystography Fluid creatinine greater than serum creatinine	Macrophages contain refractile lipid inclusions Fluid lipase/amylase/TLI greater than serum lipase/amylase/TLI	Ultrasonography Tissue biopsy Cyst aspiration + fluid analysis/cytology

TLI = trypsin-like immunoreactivity.