Peritonitis is inflammation of the peritoneal region, the tissue that lines the inside of the abdomen and supports most of the organs in the abdomen. The peritoneum is a thin layer of tissue that covers the inside of the stomach and most organs. Inflammation is usually the result of a fungal or bacterial infection caused by an abdominal injury, underlying medical condition, or treatment of a device, such as a dialysis catheter.
Peritonitis is a serious condition that requires immediate medical attention. Rapid intravenous antibiotics are needed to treat infections. Surgery is sometimes needed to remove infected tissue. Infection can spread and threaten if not treated immediately.
Causes of Peritonitis
What causes peritonitis? There are two types of peritonitis. Spontaneous bacterial peritonitis (SBP) or primary peritonitis is the result of an infection of fluid in your peritoneal cavity. Liver failure or kidney failure can cause this condition. People with conditions of peritoneal dialysis for kidney failure also experience an increased risk for SBP.
While secondary peritonitis is usually caused by an infection that spreads from the digestive tract.
The following conditions can cause peritonitis:
- Abdominal injury or injury
- Broken appendix
- Gastric ulcer or wound
- Perforated intestine
- Diverticulitis, when the sac forms on the walls of the large intestine and becomes inflamed
- Pancreatitis, is inflammation of the pancreas
- Liver cirrhosis or other types of liver disease
- Gallbladder infection, intestine, or blood flow
- Pelvic inflammatory disease, which is an infection of the female reproductive organs
- Crohn’s disease , a type of inflammatory bowel disease
- Invasive medical procedures, including treatment for kidney failure, surgery, or use of a feeding tube
Symptoms of peritonitis
What are the symptoms of peritonitis? Symptoms vary depending on the underlying cause of infection. Symptoms that often occur in peritonitis include:
- Pain in the stomach
- Pain in the abdomen is more intense with movement or touch
- Flatulence or distension
- Nausea and vomiting
- Constipation or inability to fart
- Minimum urine output (small urine )
- Anorexia , or loss of appetite
- Excessive thirst
- Fever and chills.
If you are in the condition of peritoneal dialysis, dialysis fluid may be blurry or have white spots or lumps in it. You can also see redness or pain around the catheter.
Diagnosis of Peritonitis
If you have symptoms of peritonitis, seek medical attention as soon as possible. Delaying the treatment of peritonitis can be life threatening. The doctor will ask about medical history and carry out a complete physical examination. This will include touching or pressing on the abdomen, which may cause some discomfort.
There are other tests to help diagnose peritonitis, including:
A blood test, called a complete blood count (CBC) or a complete blood count , can measure your white blood cell count. A high white blood cell count usually indicates inflammation or infection. Blood culture can help identify bacteria that cause infection or inflammation.
If you have a buildup of fluid in your stomach, your doctor can use a needle to take some liquid and send it to the laboratory for fluid analysis. Liquid culture can also help identify bacteria. Imaging tests, such as CT scans and X-rays, can show perforations or holes in a person’s peritoneum. If you are on dialysis, your doctor may diagnose you based on the condition of a cloudy dialysis fluid.
What is the treatment of peritonitis? The first step in treating peritonitis is determining the underlying cause. Treatment usually involves antibiotics to fight infections and medications for pain. If the stomach has been infected, an abscess (collection of pus), or inflammation, the patient needs surgery to remove the infected tissue.
If you are on dialysis (separating substances in solution) and experiencing peritonitis, you should wait until the infection is clean to receive dialysis again. If the infection continues, you may need to switch to other types of dialysis (other than peritoneal dialysis).
Complications of Peritonitis
If not treated immediately, the infection can enter your bloodstream, causing shock and damage to other organs. This can be fatal.
Potential complications of primary peritonitis include:
- Encephalopathy, is the loss of brain function that occurs when the liver can no longer remove toxic substances from your blood
- Hepatorenal syndrome, which is progressive kidney failure due to liver failure
- Sepsis , is a severe reaction that occurs when blood flow becomes overwhelmed by bacteria.
Complications of secondary peritonitis include:
- Intra-abdominal abscess, is a collection of pus
- Gangrenous intestine, is a dead intestinal tissue
- Intraperitoneal adhesion, is a band of fibrous tissue attached to the abdominal organs and can cause intestinal obstruction
- Septic shock, which is characterized by very low blood pressure.
How to prevent peritonitis? For certain people with cirrhosis and ascites, your doctor may prescribe antibiotics to prevent peritonitis.
Although peritonitis can be a complication of peritoneal dialysis, it is far less common than it used to be because of improved technology and self-care techniques taught during initial training.
If you receive peritoneal dialysis, you can reduce the risk of peritonitis by following these tips:
- Carefully wash your hands, including objects between your fingers and under your fingernails, before touching the catheter
- Wear a mouth or nose mask
- Observe the correct sterile exchange technique
- Apply antibiotic cream to the area outside the catheter every day.
Report immediately the possibility of contamination of dialysis fluid or catheter into your peritoneal dialysis nurse. In many cases, one dose of antibiotics can prevent contamination from becoming an infection.