Peritonitis is the infection and/or inflammation of peritoneum; inflammation of the peritoneum (the thin layer of tissue covering the inside of the abdomen and various organs within the abdomen). Peritonitis usually develops from a bacterial or less frequently, fungal infection; but there are other less often encountered causes of peritoneal inflammation.

Most individuals need quick or emergent treatment of peritonitis due to infection because infecting organisms can spread rapidly in individuals and become life-threatening.

Peritonitis Symptoms & Signs

Peritonitis is an inflammation of the peritoneum, or the lining tissues of the abdomen.

Signs and symptoms of peritonitis are mainly abdominal pain and tenderness. Other associated signs and symptoms can include:

• abdominal distension,
• bloating,
• nausea,
• vomiting,
• fever,
• chills, or
• loss of appetite.

What are the signs and symptoms of peritonitis?

Abdominal tenderness or pain that increases when the abdomen is touched or moved (palpation).

The signs and symptoms of peritonitis may vary depending upon the cause of the inflammation; however, there are relatively common indicators that suggest a person may have peritonitis. People usually have abdominal discomfort and one or more of the following:

1. Abdominal tenderness or pain.
2. Abdominal tenderness or pain that increases when the abdomen is touched or moved (palpation).
3. Abdominal swelling (bloating or distention).
4. Fever.
5. Chills.
6. Nausea.
7. Vomiting.
8. Diarrhea.
9. Decreased urination.
10. Loss of appetite (anorexia).
11. Fatigue and/or weakness.
12. Constipation.
13. Inability to pass gas.
14. Ascites (fluid in the abdominal cavity).
15. Unexplained encephalopathy (new-onset mental changes).

Causes of peritonitis

The causes of peritonitis can be grouped into five categories. The following is a list of these five categories along with some examples of their causes:

1. Primary peritonitis: Spontaneous bacterial peritonitis (SBP) is associated with ascites from patients with cirrhosis (highest risk patients for SBP), heart failure, or patients with systemic lupus and nephrosis. The majority of the cases are caused by a microbial infection.
2. Secondary peritonitis: Secondary peritonitis is caused by infection due to a perforated appendix, perforated ulcers, diverticulitis, or bowel strangulation.
3. Tertiary peritonitis: Tertiary peritonitis is caused by the bacterium Mycobacterium tuberculosis (TB) and is referred to as tuberculosis peritonitis.
4. Chemical peritonitis (also termed sterile peritonitis): Chemical peritonitis is caused by leakage of sterile fluids that are irritants to the peritoneum; for example, bile, blood, or barium used as a contrast agent during procedures and tests.
5. Peritoneal abscess: Peritoneal abscess is caused by an infected fluid collection that is encapsulated and/or adjacent to visceral organs and/or the peritoneum.

Categorizing peritonitis

Some health-care professionals choose not to categorize peritonitis; they simply use a modifier placed in front of or behind the term “peritonitis” to describe the patient’s disease, for example:

1. Bacterial peritonitis: any type of peritonitis including spontaneous bacterial peritonitis caused by a bacterial species.
2. Peritonitis appendicitis: peritonitis caused by leakage of the intestinal contents from the appendix.

   

3. Acute peritonitis: initial rapid onset of peritonitis symptoms.
4. Meconium peritonitis: fetal stool that escapes from fetal bowel before birth by rupture and results in sterile peritonitis.
5. Bile peritonitis: leakage of bile fluid into the peritoneum.
6. Septic peritonitis: infection of the peritoneum that has spread to the blood.
7. Sclerosing peritonitis: inflammation of the visceral and parietal surfaces of the abdominal cavity characterized by fibrous thickening of the peritoneum.
8. Pelvic peritonitis: inflammation involving the peritoneum surrounding the uterus and Fallopian tubes.
9. Tuberculosis peritonitis: inflammation of the peritoneum by Mycobacterium bacteria.
10. Ascites peritonitis: infection of ascites fluid causing inflammation of the peritoneum.
11. Peritonitis sintomas: Spanish for peritonitis symptoms.

Common types

• The most common type of peritonitis is secondary peritonitis, usually caused by leakage or perforation of an abdominal organ, for example the appendix.
• Another common type of peritonitis is spontaneous bacterial peritonitis (SBP) that is most often associated with individuals that have abdominal ascites fluid.

Diagnosis

Early diagnosis is important because of life threatening situation. After taking a history (ask for details about dialysis, ascites, and trauma to the abdomen etc) and perform a physical exam on the patient.

Tests should be ordered for example, a complete blood count (CBC), blood cultures, and imaging tests (ultrasound or CT scan of the abdomen/pelvis).

If possible, take a sample of the dialysis fluid for laboratory examination. If patients are with abscesses, examination of the abscess fluid should be done.

Allopathic treatment for peritonitis

Peritonitis can rapidly develop into a life-threatening problem. Depending on its cause many different doctors will be involved in the treatment; consequently, peritonitis is seen and treated by emergency medicine doctors, critical-care specialists, dialysis specialists, infectious disease specialists, gastroenterologists, hospitalists, internal medicine specialists, and surgeons. Other specialists may need to treat underlying causes.

The treatment for peritonitis begins with correction of the underlying process for example, appendicitis that has caused peritonitis or bile leakage into the abdominal cavity. In most patients with peritonitis, there is an infectious source so intravenous antibiotic therapy should be started immediately.

Try to avoid dehydration, avoiding pulmonary infections that are secondary to peritonitis, and possibly renal system support (especially in patients undergoing dialysis). Try to reduce the inflammatory response as it is also a part of supportive treatment.

Some patients may require percutaneous abscess drainage to augment antimicrobial therapy. Although there are specific suggestions for antimicrobial therapy for treating infectious peritonitis, optimal antimicrobial therapy should be individualized and depends on the types of infecting organisms and their sensitivity to antimicrobials.

What are the complications of peritonitis?

The complications of peritonitis can be extremely serious, and include:

• dehydration,
• sepsis,
• multiple organ infection and/or failure,
• hepatic encephalopathy,
• hepatorenal syndrome (liver disease leading to increasing renal failure),
• shock, and
• death.

Homeopathic treatment for Peritonitis

The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. None of these medicines should be taken without professional advice.

Apocynum Cannabinum

Apocynum acts on cellular tissue, producing oedema and dropsy and on skin causing diaphoresis, diminished frequency of the pulse is a prime indication. This is one of most efficient medicines in dropsies, ascites, infections, anasarca and hydrothorax, and urinary troubles, especially suppression and strangury, Bright’s disease, nausea with drowsiness., vomiting, drowsiness, difficult breathing. The dropsy is characterized by polydipsia (great thirst) and gastric irritability. Arrhythmia. Mitral and tricuspid regurgitation. Acute alcoholism. Relaxation of sphincters.

Aconit Nepalus

Constriction, tension and pressure in the hypochondriac region, burning pain, shootings, stinging, pressure, painful throbbing and inflammation. Ascites. Pain with rumbling in the abdomen. Loose, watery stools or stools like chopped spinach or white stools, with dark red urine. Choleraic discharges with collapse, deathly anxiety, and restlessness. Involuntary stools, from paralysis of the anus. Suppression of urine, with pressure in the bladder and pains in the loins.

Arnica Montana

Traumatic injuries, overuse of any organ, strains. Tendency to hemorrhage and low-fever states. Tendency to tissue degeneration, septic conditions, abscesses that do not mature. Stitches under ribs. Distended, offensive flatus. Sharp thrusts through abdomen. Straining of tenesmus in diarrhea. Offensive, brown, bloody, putrid, involuntary. Dysenteric stools with muscular pains. Septic conditions; prophylactic of pus infection. Apoplexy, red, full face. Vasodilating effect.

Urine retained from over-exertion. Dark brick-red sediment. Vesical tenesmus with very painful micturition.

Arsenicum Album

A profoundly acting remedy on every organ and tissue. Severe type of infections. Burning pains. Sepsis. Gnawing burning pain. Polydipsia (unquenchable thirst). Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Vomiting of blood, bile, green mucus, or brown-black mixed with blood.  Liver and spleen enlarged and painful. Ascites and anasarca. Abdomen swollen and painful. Pain as from a wound in abdomen on coughing. Painful, spasmodic protrusion of rectum. Tenesmus. Burning pain and pressure in rectum and anus. Stool small, offensive, dark, with much prostration. Dysentery dark, bloody, very offensive. High temperature. Periodicity marked adynamic. Septic fevers. Intermittent. Paroxysms incomplete, with marked exhaustion.

Rhus Toxicodendron

Abortion. Acne rosacea. After-pains. Amenorrhea. Anus, fissure of. Appendicitis. Appetite, lost. Beri-Beri. Bones, pains in. Caecum, inflammation of. Chilblains. Circulation, feeble. Cyanosis. Dengue fever. Diarrhea; chronic. Diphtheria. Dysentery. Dysmenorrhea. Dyspepsia. Ear, eczema of. Ecthyma. Enteric fever. Erysipelas. Erythema nodosum. Exostosis. Eyes, inflammation of; choroiditis; sight, weak. Feet, pains in. Gastro-enteritis. Glands, inflammation of. Gout. Hemorrhages. Hemorrhoids. Hands, pains in. Hernia. Herpes. Herpes zoster.

Hydrocele. Influenza. Intermittent. Jaw, cracking in. Liver, abscess of. Lumbago. Measles. Menorrhagia. Metrorrhagia. Neuralgia. Ovary, tumor of. Paralysis. Paraphimosis. Pemphigus. Periosteum, pains in. Pleurisy. Pleurodynia. Pneumonia; typhoid. Ptosis. Pyemia. Redgum. Relapsing fever. Rheumatism. Scarlatina. Sciatica. Sleep, restless. Smallpox. Spine, diseases of. Sprain. Strictures. Tongue, affections of. Typhus fever. Urticaria. Warts. Wens. Yawning.

Lachesis

Albuminuria. Amblyopia. Apoplexy. Appendicitis. Asthenopia. Asthma. Atheroma. Bedsores. Boils. Bubo. Caecum, inflammation of. Carbuncle. Catalepsy. Chancre. Change of life. Chilblains. Ciliary neuralgia. Cough. Cyanosis. Delirium tremens. Diphtheria. Dog-bite. Dropsy. Dyspepsia. Ears, polypus of; wax in; noises in. Enteric fever. Epilepsy. Erysipelas. Eyes affections; hemorrhage into. Fainting. Fistula lachrymalis. Flatulence. Fungus hematodes. Gallstones. Gangrene. Glanders. Hemorrhages. Hemorrhoids. Hay fever.

Headache. Heart affections. Heartburn. Hemiplegia. Hysteria. Injuries. Intermittent fever. Jaundice. Leprosy. Liver affections. Locomotor ataxy. Malignant pustule. Measles. Morvan’s disease. Neuralgia. Neurasthenia. Ovaries affections. Paraphimosis. Peri typhlitis. Perspiration, bloody; absent. Phlegmasia alba dolens. Plague. Pneumonia. Puerperal fever and convulsions. Purpura. Pyemia. Quinsy. Rabies. Scarlatina. Sciatica. Scurvy. Strangury colic. Syphilis. Traumatic fever. Tumors. Ulcers. Veins, varicose. Vertigo. Warts. Whitlow. Wounds.

Podophyllum

Acidity. Amenorrhea. Anal Prolapse. Asthma, bronchial. Bilious attack. Bronchitis. Diarrhea; camp. Duodenal infections. Dysentery. Dysmenia. Dyspepsia. Fevers. Flatulence. Gagging. Gallstones. Gastric catarrh. Hemorrhoids. Intermittent. Jaundice. Leucoma. Liver affections. Ovaries pains, numbness, tumor. Palpitation. Pneumonia. Proctitis. Prostatitis. Pustules. Taste lost, perverted, illusions of. Tenesmus. Worms. Vasodilator.

Phosphorus

Pain in stomach; relieved by cold food, ices. Region of stomach painful to touch, or on walking. Inflammation and infections of stomach or abdominal organs, with burning extending to throat and bowels, bad effects of eating too much salt, abdomen feels cold, sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration. Jaundice. Pancreatic disease. Large, yellow spots on abdomen. Stool very fetid stools and flatus. Long, narrow, hard, like a dog’s. Difficult to expel. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids. Hematuria, especially in acute Bright’s disease. Turbid, brown. Stupid delirium. Profuse perspiration.

Colchicum

Appendicitis. Asthma. Cataract. Cholera. Colic. Cough. Cramp. Debility. Diabetes. Diarrhea. Dropsy. Dysentery. Eyes infections. Feels, painful. Gout. Heart affections. Ileus sepsis. Intermittent fever. Intestinal catarrh and infection. Lumbago. Myalgia. Nephritis (rheumatic and gouty). Pericarditis. Proctalgia. Prostatitis. Rectal prolapse. Rheumatism. Stiff neck. Tongue, sensibility lost. Typhlitis. Typhoid fever.

China Officianalis

Abscess. Alcoholism. Amblyopia. Anemia. Aphthae. Apoplexy Appetite, disordered. Asthma. Back weakness. Bilious attack. Catarrhal affections. Coma. Constipation. Cough. Debility. Delirium. Diarrhea. Dropsy. Dyspepsia. Deafness. Tinnitus. Otorrhea. Empyema. Gall-stone colic. Hemorrhages. Hemorrhoids. Headache. Hectic fever. Hip-joint disease. Ichthyosis. Intermittent fever. Jaundice. Labour. Leucorrhea. Lienteria. Liver diseases. Liver cirrhosis of. Meniere’s disease. Menstruation, disordered. Muscae volitantes. Neuralgia. Peritonitis. Perspiration, excessive. Pleurisy. Prosoplasia. Psoriasis. Pylorus, disease of. Rheumatism. Self-abuse. Sleep, disordered. Spleen infections. Taste, disordered. Traumatic fever. Tympanites. Varicose veins. Vertigo.

Bryonia Alba

Aphthae. Apoplexy. Asthma. Bilious attack. Cancer. Chlorosis. Constipation. Consumption. Coryza. Cough. Dentition. Diaphragmal rheumatism. Diarrhea. Dropsy. Dyspepsia. Eczema. Enteric fever. Eruptions. Gastroenteritis. Sepsis. Hemorrhages. Hands, swollen. Headache. Heart inflammation. Hernia. Hiccough. Intermittent fevers. Jaundice. Joints pain. Liver disorders. Lumbago. Measles. Vicarious. Miliaria. Myalgia. Nephritis. Peritonitis. Phlegmasia alba dolens. Pleurisy. Pleurodynia. Pneumonia. Pregnancy morning cough; pregnancy sickness. Puerperal fever. Pyuria. Relapsing fever. Remittent fever. Rheumatism. Scarlatina. Screaming. Side pain. Sleep – anxious dreams in. Spina bifida. Stiff neck. Suppressed eruption’s, bad effects. Thirst. Tongue coated. Vertigo. Waking, starts and screams on. Water-brash. Yellow fever.

Belladonna

Abscess. Acne. Amaurosis. Apoplexy. Bladder weakness. Boils. Brain, affections of. Bronchial glands, disease of. Colic. Constipation. Convulsions. Cough. Croup. Delirium tremens. Depression. Diarrhea. Dysentery. Ear infections. Enteric fever. Epilepsy. Erysipelas. Erythema. Excitement. Eye infections. Glandular swellings. Gout. Hemorrhoids. Headache. Heart affections. Hydrocephalus. Hyperemia. Influenza. Kidney infections. Lungs infections. Malignant pustule. Mania. Measles. Menstruation. Neuralgia. Nyctalopia. Nymphomania. Paralysis. Para metritis. Perichondritis. Peri metritis. Peritonitis. Phlegmasia alba dolens. Pleurisy. Pneumogastric paralysis. Pneumonia. Pregnancy disorders. Puerperal mania. Rheumatism. Roseola. Scarlatina. Sensitiveness. Sleep disorders. Smell disorders. Strangury. Taste disordered. Tenesmus. Thirst. Tuberculosis. Ulcers. Uterine affections. Vaccinia. Vertigo. Whooping-cough. Worm fever.

Bellis Perensis

Acne. Arteries diseases. Boils. Brain, softening of. Change of Life. Exudations. Fatigue. Giddiness. Gout. Headache. Indigestion. Mydriasis. Overwork. Pregnancy complaints. Psoriasis. Rheumatism. Sleeplessness. Spleen diseases. Stasis. Traumatism. Tumors. Uterus, fatigued. Varicose.

Apis Mellifica

Abscess. Apoplexy. Bladder affections. Carbuncle. Chancre. Constipation. Diarrhea. Diphtheria. Dissection wounds. Dropsy. Ear, erysipelas of. Erysipelas. Erythema nodosum. Gangrene. Gout. Hands swelling. Heart affections. Heat-spots. Infections. Sepsis. Injuries. Intermittent fever. Irritation. Joints synovitis. Kidney, Bright’s disease. Labia inflammation. Lichen. Meningitis. Panaritium. Pannus. Peritonitis. Phlebitis. Pleurisy. Prostatitis. Puncture wounds. Red gum. Rheumatism. Scarlatina. Suppressed eruptions effects. Sycosis. Syphilis. Throat, sore. Tongue edema; tongue ulceration. Sepsis. Tumors. Typhus. Urethritis. Urine, abnormalities of. Vaccination. Varicose veins. Variola. Wounds.

Pulsatilla

Acne. Amaurosis. Anemia. Appetite depraved. Bladder infection. Blepharospasm. Catarrh. Chaps. Chilblains. Clavus. Cold. Cough. Diarrhea of phthisis. Distension. Dysmenia. Dyspepsia. Epistaxis. Inflammation. Fear. Gonorrhea. Gout. Hemorrhoids. Hands, pains in. Heart palpitation. Hysteria. Intermittent fever. Joints synovitis. Labour spurious pains. Vicarious. Moles. Mumps. Neuralgia. Nymphomania. Phlegmasia alba dolens. Pregnancy; bladder trouble of; sickness of; diarrhea of. Priapism. Prostate inflammation. Prostatorrhea. Puerperal convulsions, fever, mania. Retained placenta. Rheumatism; gonorrheal. Pain in abdomen. Sepsis. Synovitis. Tapeworm. Tongue coated. Urine incontinence. Veins inflammation; varicose. Whitlow.

Silicea Terra

Abdomen distended. Ascites. Abscess. Acne. Anemia. Anal fissure; Fistula. Appetite depraved. Spinal weakness. Boils. Bones necrosis. Brain-fag, infection. Bunion. Cancer. Carbuncle. Cataract. Cellulitis. Cheloid. Cicatrix. Circulation feeble. Coccygodynia. Constipation. Debility. Dentition. Diabetes. Elephantiasis. Enchondroma. Enuresis. Fibroma. Fistula. Foot-sweat; suppressed. Foreign bodies expulsion. Fractures. Ganglion. Gastric catarrh. Glandular swellings. Headache. Hernia. Hip-joint disease. Homesickness. Joints synovitis. Locomotor ataxy. Mania. Metrorrhagia. Molluscum contagiosum. Molluscum fibrosum. Morphea. Morvan’s disease. Necrosis. Sepsis. Neuralgia. Nodes. Panaritium. Para metritis. Perspiration offensive. Phimosis. Pleurisy. Psoas abscess. Pylorus suppuration. Rheumatism. Rickets. Sinuses. Somnambulism. Spinal irritation. Strains. Strangury. Suppuration. Tenesmus. Tumors. Ulcers. Peritonitis. Urethral stricture. Urine incontinence. Vaccination. Vaginal spasms. Vertigo. Whitlow. Worms.

Merc Solubilis

Abscess. Anemia. Aphthae. Appendicitis. Balanitis. Bone disease. Brain inflammation. Breath, offensive. Bronchitis. Bubo. Oral cancer. Catarrh. Chancre. Chickenpox. Condylomas. Diarrhea. Dysentery. Dyspepsia. Ecthyma. Eczema. Emaciation. Excoriation. Gouty inflammation. Fainting. Fevers. Fissures. Glandular swellings. Heart affections. Jaundice. Joints affections. Liver affections. Peritonitis. Lumbago. Mania. Meningitis. Mollities ossium. Mucous patches. Mumps. Offensive odor of body. Pancreatitis. Para metritis. Parotitis. Perspiration abnormal. Phimosis. Prostate disease. Pyemia. Rheumatism. Stomatitis. Surgical fever. Syphilis. Taste disordered. Throat-deafness. Tongue, affections; mapped. Typhus fever. Ulcers. Vaccination. Vomiting.

Nux Vomica

Acne rosacea. Alcoholism. Amaurosis. Amblyopia. Anger, effects of. Apoplexy. Asthma. Bilious attack. Biliousness. Bladder, affections of. Bone, nodes on. Brain, affections of. Breath, sour. Catarrh. Clavus. Colic. Constipation. Convulsions. Cramp. Delirium. Diarrhea. Dysentery. Dyspepsia. Emissions. Gouty inflammation. Gallstones. Gastrodynia. Gout. Hemorrhoids. Headache. Heart affections. Hernia. Hypochondriasis. Intermittent fever. Lisping. Liver disorders. Locomotor ataxy. Lumbago. Muscae volitantes. Myelitis. Paralysis; spastic. Paraphimosis. Peritonitis. Pregnancy affections; spurious. Pylorus, disease of. Renal calculi. Seasickness. Sexual perversion. Sleep abnormal. Urethral spasm. Urine frequent passing. Vertigo. Waterbrash. Worms.

Myrica Cerifera

A best Homeopathic antibiotic. Marked action on abdominal organs. Persistent sleeplessness. Jaundice. Despondent, irritable, indifferent. Gloomy. Scalp feels tight. Headache, with drowsiness; yellow and sclerotic; aching in eyeballs, dull, heavy aching in temples and forehead on waking in the morning. Pain and stiffness in nape of neck. Pressure in vertex and forehead. Face yellow, Itching and stinging. Creeping sensation. Staggering gait. Pain under shoulder-blades and back of neck, in all muscles, in hollow of right foot.

Tongue furred, with bad taste in mouth, and nausea. Tenacious, thick, nauseous secretion. Tender, spongy and bleeding gums. Constricted and rough feeling in throat, with a constant desire to swallow. Stringy mucus; detached with difficulty. Mouth taste bitter and nauseous, with offensive breath. Complete loss appetite, but with a feeling of fullness in the stomach after a hearty meal. Strong desire for acids. Weak, sinking feeling in the epigastrium, approaching nausea; increased after eating; relieved by rapid walking.

Dull pain in the region of the liver. Complete jaundice, with bronze-yellow skin; loss of appetite. Fullness in the stomach and abdomen. Scanty, yellow, frothy urine. Constant discharge of flatus when walking. Urging to stool, with no other results than the expulsion of a great amount of flatus. Loose, light-colored stool; ash-colored and destitute of bile. Urine dark, frothy, scanty, high-colored, biliary.

Symphytum Officinale

Gastric and duodenal juries to sinews, tendons and the periosteum. Acts on joints generally. Neuralgia of knee. Symphytum is a good antibiotic and its great use in wounds penetrating to perineum and bones, and in non-union of fractures, irritable stump after amputation, irritable bone at point of fracture. Psoas abscess. Pricking pain and soreness of periosteum.

Pain in occiput, top and forehead, nose; changing places. Inflammation of inferior maxillary bone (hard, red, swelling). For traumatic injuries of the eyes no remedy equals this.

Prognosis

The prognosis for individuals who develop peritonitis depends on both the underlying cause and how rapidly the disease is treated. The prognosis can range from good to poor. For example, individuals that are treated appropriately with antibiotics/antimicrobials and surgery for peritonitis caused by appendicitis often have a good outcome. However, individuals with long-standing diseases such as liver failure that develop hepatorenal syndrome and peritonitis have a poor prognosis.

Can peritonitis be prevented?

• Prevention or reduction in the chance of developing peritonitis can be done by preventing underlying causes (for example, trauma, ulcers, alcoholic cirrhosis, and pelvic inflammatory disease).
• Patients that are obtaining peritoneal dialysis should be very careful about his/her own sanitation (hand and fingernail cleanliness) to avoid contamination to the dialysis catheter. Skin adjacent to the dialysis catheter should be cleaned daily, and patients should follow instructions given to them by their dialysis team.
• Preventive use of antibiotics/antimicrobials have been used to reduce the risk peritonitis; however, if this technique is used, it may generate not only antibiotic resistant organisms over time, but too many other complications (there side effects) could generate other diseases and complications.

PS: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

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