Changes

The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms. This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ''ajatodakavastha'' of ''udara''.

The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms. This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ''ajatodakavastha'' of ''udara''.

As the inflammation continues gradually the fluid starts accumulating. The features of gaseous distension are going to be masked by the fluid accumulation. This phase of peritonitis is indicative of ''picchavastha'' of '''udara'''.  

As the inflammation continues gradually the fluid starts accumulating. The features of gaseous distension are going to be masked by the fluid accumulation. This phase of peritonitis is indicative of ''picchavastha'' of ''udara''.  

Further as the fluid accumulates, the patient develops the complete symptoms of ascites that include horse shoe dullness, shifting dullness and fluid thrill. This stage of peritonitis is considered as jātodakāvasthā of udara40 [48-49].

Further as the fluid accumulates, the patient develops the complete symptoms of ascites that include horse shoe dullness, shifting dullness and fluid thrill. This stage of peritonitis is considered as ''jatodakavastha'' of ''udara''40 [48-49].

===== Current management =====

===== Current management =====