Peritonitis
The peritoneum is the lining of the inner abdominal wall. It serves as a protective covering for the abdominal organs. Peritonitis is a bacterial or fungal infection of the peritoneum.
Types of Peritonitis
There are two types of peritonitis: primary peritonitis, which originates in the peritoneum and secondary peritonitis, which is the result of an injury or infection that spreads into the abdominal cavity and affects the peritoneum. Peritonitis may occur for a variety of reasons.
Primary Peritonitis
Primary peritonitis may be the result of liver disease. Such disease may cause a buildup of abdominal fluid which may then become infected. Primary peritonitis may also result from peritoneal dialysis which involves the insertion of a catheter into the peritoneum. The insertion of this catheter opens the area to possible bacterial or fungal contamination.
Secondary Peritonitis
There are many causes of secondary peritonitis. These may include:
- Digestive disorders such as diverticulitis or Crohn's disease.
- A rupture of a stomach ulcer, the appendix, or a diverticulum
- Perforations, accidental or surgical, of an abdominal organ
- Penetration of the abdomen by stabbing or gunshot
- Pancreatitis
- Pelvic inflammatory disease or an infection of the fallopian tubes
Peritonitis may also result from the introduction of a substance, such as bile, blood, or barium into the abdominal cavity or, very rarely, occur spontaneously for no apparent reason.
Symptoms of Peritonitis
Since peritonitis may be a life-threatening condition, patients should be alert to its symptoms, especially after abdominal disease or injury, abdominal surgery or when undergoing peritoneal dialysis. Symptoms of peritonitis may include:
- Fever
- Chills
- Abdominal pain or bloating
- Loss of appetite
- Nausea
- Vomiting
- Thirst
- Fatigue
- Inability to pass stool or gas
- Urinary retention
Dialysis patients should contact their health care providers if their dialysis fluid shows any of the following signs of contamination:
- Cloudiness
- Contains white flecks
- Contains clumps or strands
- Odor
Diagnosis of Peritonitis
To diagnose peritonitis, a doctor will perform a physical examination and review of the patient's medical history. The first signs of peritonitis include severe abdominal pain and an absence of bowel sounds. Additional testing is often necessary to accurately diagnose peritonitis. Tests may include:
- Blood tests
- Imaging tests, such as X-rays or CT scans
- Laboratory culture of peritoneal fluid
- Exploratory surgery
Risks of Peritonitis
The most dangerous risk of peritonitis is sepsis and septic shock which require immediate intensive care. Sepsis occurs when the body mobilizes to attack systemic infection by releasing chemicals into the bloodstream. These chemicals trigger inflammation throughout the body which may cause organ failure. If septic shock occurs, the patient's blood pressure drops precipitously and the patient may not survive.
Treatment of Peritonitis
Peritonitis is a very serious condition, requiring hospitalization. Patients with peritonitis are normally treated with intravenous medications, antibiotics or antifungal preparations as the case warrants. Blood transfusions are often necessary as well. In extreme cases, especially those caused by appendicitis, diverticulitis or perforated stomach ulcers, emergency surgery to remove any infected or damaged peritoneal tissue may be required. With peritonitis caused by peritoneal dialysis, medication may be injected directly into the peritoneal tissue. Until the peritonitis is effectively treated, dialysis patients must use another method of dialysis.
While peritonitis is very serious, due to new methods of treatment the majority of patients now recover from this condition. The mortality risk is higher for patients with cirrhosis.