Peritonitis

Overview

Peritonitis is a serious medical condition characterized by inflammation of the peritoneum, the thin tissue lining the inner wall of the abdominal cavity. It is typically caused by an infection from bacteria or fungi. There are two types of peritonitis: spontaneous bacterial peritonitis and secondary peritonitis. Spontaneous bacterial peritonitis is caused by bacteria and can occur in individuals with liver or kidney diseases. Secondary peritonitis can result from a hole or rupture inside an organ in the abdomen or other health conditions. Peritonitis is a life-threatening condition that requires immediate medical attention, often involving antibiotics and, in some cases, surgery. Untreated peritonitis can lead to a severe infection that spreads throughout the body, potentially being fatal.

Understanding the disease

Symptoms

Symptoms of peritonitis include:

• Belly pain or tenderness.
• Bloating or a feeling of fullness in the abdomen.
• Fever.
• Upset stomach and vomiting.
• Loss of appetite.
• Diarrhea.
• Reduced urine.
• Thirst.
• Not able to pass stool or gas.
• Feeling tired.
• Confusion. If you get peritoneal dialysis, peritonitis symptoms may additionally include:
• Cloudy dialysis fluid.
• White flecks, strands, or clumps, called fibrin, in the dialysis fluid. If you experience any of these symptoms, it is important to contact your healthcare provider immediately.

Risk Factors

The risk factors for developing peritonitis include:

1. Peritoneal dialysis - Peritonitis can occur in individuals undergoing this treatment.
2. Other medical conditions - Certain health conditions such as liver cirrhosis, appendicitis, stomach ulcers, diverticulitis, Crohn's disease, and pancreatitis can increase the risk of peritonitis.
3. History of peritonitis - Individuals who have had peritonitis in the past may be more susceptible to developing it again. Peritonitis can be caused by bacterial or fungal infections. It's crucial to seek prompt medical attention if you experience symptoms such as abdominal pain, fever, nausea, vomiting, or a feeling of general illness. Early diagnosis and treatment can help prevent complications like sepsis, which can be life-threatening.

Development

Peritonitis can develop in two main ways:

1. Spontaneous bacterial peritonitis (SBP): This type of peritonitis occurs in individuals with underlying liver or kidney disease. In people with advanced liver cirrhosis, the accumulation of fluid in the abdomen (ascites) can lead to bacterial infection, causing SBP.
2. Secondary peritonitis: This type of peritonitis is caused by an infection that originates from a hole or rupture in an organ within the abdominal cavity, such as the stomach, colon, or another organ. Secondary peritonitis can also be caused by other health conditions like appendicitis, diverticulitis, or injuries to the abdomen. In both cases, the bacteria or other pathogens invade the peritoneal cavity, causing inflammation and infection. Symptoms of peritonitis can include severe abdominal pain, fever, nausea, vomiting, and changes in the color or odor of the fluid around the catheter (in case of peritoneal dialysis). It's crucial to seek medical attention promptly if you suspect peritonitis, as it can be life-threatening if left untreated.

Assessment and Diagnosis

Triage

If peritonitis is suspected, you should see a doctor right away. You should call your health care provider or seek immediate medical attention if you experience severe pain or tenderness in your abdomen, along with bloating, fever, upset stomach, vomiting, reduced urine, thirst, and difficulty passing stool or gas. These symptoms could indicate peritonitis, which can be life-threatening if not treated promptly. Additionally, if you receive peritoneal dialysis and notice cloudy or unusual-colored dialysis fluid with white flecks, strands, or clumps, contact your health care provider immediately.

Diagnosis

To diagnose peritonitis, your healthcare provider will discuss your medical history and perform a physical exam. If further tests are needed to confirm the diagnosis, they may suggest blood tests to check for increased white blood cells, which indicate infection or inflammation. Imaging tests like X-rays, ultrasounds, or CT scans may be conducted to check for any tears or holes in the digestive tract. A peritoneal fluid analysis may also be done by taking a sample of the fluid in your peritoneum, which can indicate an infection or inflammation if there is an increased white blood cell count.

Management and Treatment

Complications

Potential complications of peritonitis include:

1. Sepsis: Without timely treatment, peritonitis can lead to a whole-body infection called sepsis, which can cause shock, organ failure, and death.
2. Organ failure: Severe peritonitis can cause damage to the organs in the abdominal cavity, such as the liver, pancreas, or intestines. This damage can lead to organ failure and long-term complications.
3. Abscess formation: In some cases, pus-filled abscesses can form in the abdominal cavity, which may require drainage or surgical intervention.
4. Increased risk of recurrence: Once you've had peritonitis, your risk of getting it again may be higher than that of someone who's never had it. This is particularly true if the initial case was caused by peritoneal dialysis or another medical condition like liver cirrhosis or diverticulitis.
5. Delayed recovery and prolonged hospital stay: Peritonitis can require extended hospital stays for treatment with antibiotics, drainage of abscesses, or surgical intervention. Recovery may be slow and exhausting, and the individual may need rehabilitation to regain strength and mobility. It's crucial to seek medical attention promptly if you suspect peritonitis, as early treatment can help prevent serious complications and improve the chances of a successful recovery.

Prevention

Peritonitis can be prevented to some extent. Prevention measures depend on the specific cause and context, but generally, good hygiene and maintaining proper care can help reduce the risk. For individuals undergoing peritoneal dialysis, following the recommended guidelines for hygiene and catheter care can significantly lower the chances of contracting peritonitis. Always consult with a healthcare provider for personalized advice on prevention and management strategies.

Treatment

Peritonitis is a life-threatening condition that requires immediate medical attention. Treatment typically involves the following:

1. Antibiotics: Health care providers usually prescribe antibiotics to treat peritonitis caused by bacterial infections. The choice of antibiotics depends on the specific bacteria causing the infection.
2. Surgery: In some cases, surgery may be necessary to remove any ruptured organs, drain abscesses, or repair any holes or abnormalities in the abdominal cavity.
3. Drainage of peritoneal fluid: If there is a buildup of peritoneal fluid due to a medical condition such as liver cirrhosis, your healthcare provider may prescribe medications to reduce the fluid or perform a procedure to drain excess fluid.
4. Preventive measures: For those undergoing peritoneal dialysis, good hygiene practices, such as cleaning the skin around the catheter with an antiseptic, storing supplies in a clean place, wearing a surgical mask during dialysis fluid exchanges, and following the proper care instructions provided by the dialysis care team, can help prevent peritonitis. Prompt treatment is crucial to avoid serious complications and reduce the risk of death. If you suspect peritonitis, seek immediate medical attention.

Preparing for medical consultation