94 THE ALIMENTARY TRACT. 
PERITONEUM. 
Name the different forms of inflammation of the peritoneum. 
Acute and chronic peritonitis, and tubercular peritonitis, If the 
greater part of the peritoneum is inflamed it is called a general 
peritonitis, if only a circumseribed part is affected then it is called a 
local peritonitis, 
What are the varieties of acute peritonitis ? 
Cellular and exudative. 
In the former variety there is a marked congestion. Microscopically 
there is a great increase in the size and number of the endothelial cells 
covering the péritoneum. There is no production of serum, fibrin and 
pus. In the exudative type there are present the changes found with 
exudative inflammations elsewhere, viz.: serum, fibrin and pus. There 
is an increased growth of endothelial cells which may form adhesions. 
What are the varieties of chronic peritonitis ? 
Cellular peritonitis, peritonitis with adhesions, chronic peritonitis 
with thickening of the peritoneum, and chronic peritonitis with the 
production of fibrin, serum and pus. 
What are the minute changes in the first two forms of chronic 
peritonitis ? 
In the first form the surface of the peritoneum is covered with cells 
of different shapes, which appear to have been derived from the endo- 
thelial and connective-tissue cells which make up the peritoneum. 
The second form seems to be this process continued until adhesions 
are formed. : 
Give the minute changes in the last two forms of peritonitis. 
In the variety known as chronic peritonitis with thickening, the 
most noticeable feature is the thickening of the peritoneum. The 
outer part of the thickened portion consists of fibrous connective 
tissue and the inner layers of granulation tissue. The peritoneum may 
be an inch thick. The peritoneal cavity may contain clear or purulent 
serum. In the last form of chronic peritonitis there is a production 
of fibrin, serum and pus. The different parts may be matted together 
with the fibrin. 
What are the changes in tubercular peritonitis ? 
They are the same as are common to all tubercular inflammations. 
The tubercular growth may occur as miliary tubercles or as diffuse 
infiltration. There may also be a production of serum, fibrin and pus in 
varying proportions. 
