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PERITONITIS

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PERITONITIS

Peritonitis is the inflammation of the peritoneum, the tissue that lines the inner abdominal wall and covers and supports the organs within the abdomen.

  • The peritoneum is a membrane made up of 2 layers. One layer lines the cavity and the other layer lines the organ.
  • The peritoneum helps support organs in the abdominal cavity and allows nerves, blood vessels, and lymph vessels to pass through the organs.
  • Peritonitis is a serious and urgent condition that requires immediate treatment
  • If left untreated, peritonitis can lead to severe, potentially life-threatening infection throughout the body.
  • There are two types of peritonitis: secondary peritonitis and spontaneous peritonitis
  • It is secondary if it develops when an injury or medical condition in the abdominal cavity allows infectious organism into the peritoneum and spontaneous if the infection arises from fluid buildup in the abdominal cavity.

CAUSES

The inflammation usually results from a fungal or bacterial infection. In most cases, the infection is caused by a rupture within the abdominal wall. In rare cases, the condition can develop without an abdominal rupture, this type is termed spontaneous peritonitis.

The following are causes of secondary peritonitis

  • A ruptured appendix
  • Perforated colon
  • A stomach ulcer
  • Abdominal trauma or injury
  • Digestive diseases such as Chron’s disease or diverticulitis
  • Pancreatitis
  • Ingestion of a sharp foreign body such as a toothpick, fishbone, or glass shard
  • Invasive medical procedures, including peritoneal dialysis, use of feeding tubes.
  • Pelvic inflammatory disease
  • Surgical Wound

The most common cause of spontaneous peritonitis results from a complication of liver disease, such as cirrhosis. In its advanced stage, cirrhosis causes a large amount of fluid buildup in the abdominal cavity.

Noninfectious cause of the condition includes leakage of fluids into the peritoneum such as blood, gastric juice, urine, bile.

The following may increase your risk of getting the conditions:

  • A previous history of the condition
  • History of alcoholism
  • Weakened immune system
  • Fluid accumulation in the abdomen
  • Liver disease

SYMPTOMS

  • Fever and chills
  • Abdominal pain or tenderness
  • Abdominal bloating
  • Abdominal distention
  • Nausea and vomiting
  • Diarrhea
  • Minimal urine output
  • Excessive thirst
  • Fatigue
  • Constipation or inability to pass stool or gas

If you are on peritoneal dialysis, symptoms may include cloudy dialysis fluid, white flecks or clumps in the dialysis fluid. You may also feel pain or redness around the catheter.

DIAGNOSIS AND TREATMENT

When peritonitis is associated with peritoneal dialysis, the symptoms especially cloudy dialysis fluid may be enough for the doctor to diagnose the condition.

If otherwise, the doctor will ask you about your medical history and perform a complete physical exam, including assessment of tension and tenderness in the abdomen.

Diagnostic test for peritonitis includes:

  • Blood tests to check for a high white blood cell count.
  • Imaging tests such as X-ray to check for holes in the gastrointestinal tract. Ultrasound may be used and in some cases, the doctor will use a CT scan instead of X-ray.
  • Peritoneal fluid analysis where a sample of the fluid inside your peritoneum is taken especially if you receive peritoneal dialysis or have fluid from liver disease. The fluid may show an increase in white blood cell counts if peritonitis is present.

TREATMENT

The first step in treating peritonitis is determining its underlying cause.

If your condition is the secondary type, hospitalization may be needed.

Antibiotics may be given and can be applied directly to the blood using intravenous injection.

Surgical treatment may be necessary to remove infected tissue, treat the underlying cause of the infection and prevent infection from spreading especially if it is due to a ruptured appendix, colon or stomach.

Other treatment while in the hospital may include pain medications and supplemental oxygen

For individual undergoing peritoneal dialysis, the doctor may recommend that dialysis is given in another way for days while the body heals from the infection.

You can lower your risk by:

  • Thoroughly washing your hands including areas between and underneath the finger before touching the catheter.
  • Apply antibiotic cream to the catheter exit every day.