Peritonitis: Symptoms, Causes, Treatment

What are the symptoms of peritonitis?

Peritonitis is an inflammation of the peritoneum, the lining of the abdominal cavity. It can be caused by infection or irritation and can be a serious medical condition. The symptoms of peritonitis can vary depending on the underlying cause, but common symptoms include:

1. Abdominal Pain:

• Description: Severe, diffuse, and constant pain in the abdomen.
• Characteristics: Pain may be sharp or dull and can worsen with movement or palpation.

2. Abdominal Tenderness:

• Description: The abdomen may be tender to touch.
• Characteristics: Increased sensitivity and discomfort when pressure is applied to the abdomen.

3. Abdominal Distension:

• Description: Swelling or bloating of the abdomen.
• Characteristics: The abdomen may appear enlarged or feel tight.

4. Nausea and Vomiting:

• Description: Feelings of nausea and episodes of vomiting.
• Characteristics: Often accompanied by a loss of appetite.

5. Fever and Chills:

• Description: Elevated body temperature and chills.
• Characteristics: Common in cases where peritonitis is caused by infection.

6. Rapid Breathing and Rapid Heart Rate:

• Description: Increased respiratory rate and heart rate.
• Characteristics: These may occur as the body responds to pain and inflammation.

7. Reduced Urine Output:

• Description: Decreased frequency of urination or low urine output.
• Characteristics: May indicate severe infection or dehydration.

8. Constipation or Diarrhea:

• Description: Changes in bowel movements, including constipation or diarrhea.
• Characteristics: May occur depending on the severity and location of inflammation.

9. General Malaise:

• Description: A general feeling of illness, weakness, or discomfort.
• Characteristics: May be accompanied by fatigue and a feeling of being unwell.

10. Rebound Tenderness:

• Description: Pain that worsens when pressure on the abdomen is suddenly released.
• Characteristics: Indicates irritation of the peritoneum and is often assessed during physical examination.

Summary:

Peritonitis typically presents with severe abdominal pain, tenderness, distension, nausea, vomiting, fever, and changes in bowel habits. Rapid breathing and heart rate, reduced urine output, and general malaise may also be present. The condition requires prompt medical evaluation and treatment, as it can lead to serious complications if left untreated. If peritonitis is suspected, it is important to seek medical attention immediately for appropriate diagnosis and management.

What are the causes of peritonitis?

Peritonitis can result from various causes, which generally fall into two main categories: infectious and non-infectious. Here’s a breakdown of the causes:

1. Infectious Causes:

• Bacterial Infection:
• Primary Peritonitis: Infection that originates within the peritoneal cavity without an obvious source. Often associated with conditions like cirrhosis or nephrotic syndrome.
• Secondary Peritonitis: Results from a bacterial infection that spreads to the peritoneum from another source, such as:
  • Appendicitis: Infection of the appendix that can spread to the peritoneum if the appendix ruptures.
  • Diverticulitis: Infection or inflammation of diverticula (small pouches) in the colon that can lead to perforation and peritonitis.
  • Peptic Ulcer Perforation: Ulcers in the stomach or duodenum that perforate, allowing stomach acid and bacteria to enter the peritoneal cavity.
  • Cholecystitis: Inflammation of the gallbladder that can lead to infection if it ruptures.
  • Intestinal Obstruction or Ischemia: Blockage or reduced blood supply to the intestines that can cause bowel necrosis and peritonitis.
  • Post-Surgical Complications: Infections following abdominal surgery.
• Tuberculous Peritonitis:
• Caused by Mycobacterium tuberculosis, often associated with disseminated tuberculosis.
• Fungal Peritonitis:
• Less common, can occur in immunocompromised individuals or following abdominal surgery.

2. Non-Infectious Causes:

• Chemical Irritation:
• Leakage of Gastric Acid: From perforated ulcers or other sources.
• Bile Leak: From a ruptured gallbladder or bile ducts.
• Pancreatic Enzymes: From pancreatitis, which can lead to chemical irritation of the peritoneum.
• Autoimmune Conditions:
• Systemic Lupus Erythematosus (SLE): Can cause inflammation of the peritoneum.
• Trauma:
• Abdominal Injury: Physical trauma to the abdomen that causes bleeding or leakage of intestinal contents.
• Endometriosis:
• Endometriosis: When tissue similar to the lining of the uterus grows outside the uterus, it can cause inflammation and irritation in the peritoneum.
• Peritoneal Dialysis:
• Dialysis-Related Peritonitis: Infection or inflammation caused by the dialysis solution used in patients undergoing peritoneal dialysis.

Summary:

Peritonitis can be caused by a variety of factors, including bacterial infections (primary or secondary), chemical irritation, autoimmune conditions, trauma, endometriosis, and complications from medical procedures like peritoneal dialysis. Identifying the underlying cause is crucial for effective treatment, and timely medical evaluation is essential to manage the condition and prevent serious complications.

How is the diagnosis of peritonitis made?

Diagnosing peritonitis involves a combination of clinical evaluation, imaging studies, laboratory tests, and sometimes invasive procedures. Here is a comprehensive overview of the diagnostic approach:

1. Medical History and Physical Examination:

• Medical History:
• Symptoms: Discussion of symptoms such as abdominal pain, tenderness, fever, nausea, and vomiting.
• Recent Events: Information about recent surgeries, trauma, or underlying medical conditions.
• Physical Examination:
• Abdominal Examination: Assessment for signs of tenderness, distension, rebound tenderness, and guarding.
• Vital Signs: Checking for fever, elevated heart rate, and rapid breathing.

2. Laboratory Tests:

• Blood Tests:
• Complete Blood Count (CBC): To check for elevated white blood cell count (leukocytosis), indicating infection or inflammation.
• Serum Electrolytes and Renal Function Tests: To assess overall health and identify potential complications.
• C-Reactive Protein (CRP): Elevated levels may indicate inflammation.
• Blood Cultures: To identify bacterial pathogens if an infection is suspected.
• Peritoneal Fluid Analysis:
• Procedure: If there is ascitic fluid (fluid in the abdominal cavity), a sample may be obtained via paracentesis (needle insertion).
• Analysis: The fluid is analyzed for:
  • Cell Count and Differential: To determine the presence of infection or inflammation.
  • Culture and Sensitivity: To identify bacterial or fungal pathogens.
  • Biochemical Tests: To assess fluid characteristics and possible sources of irritation.

3. Imaging Studies:

• Ultrasound:
• Purpose: To detect fluid accumulation in the abdomen, assess for abscesses or free fluid, and guide further diagnostic procedures.
• Procedure: High-frequency sound waves are used to create images of the abdominal structures.
• Computed Tomography (CT) Scan:
• Purpose: Provides detailed images of the abdomen to identify the source of peritonitis, such as perforations, abscesses, or tumors.
• Procedure: Cross-sectional imaging helps visualize the extent and location of inflammation or infection.
• X-ray:
• Purpose: May be used to detect free air under the diaphragm, which can indicate perforation of a hollow organ.
• Procedure: Plain abdominal X-rays can be used in some cases but are less detailed than CT scans.

4. Invasive Procedures:

• Paracentesis:
• Purpose: To obtain a sample of ascitic fluid for analysis.
• Procedure: Involves inserting a needle into the abdominal cavity to collect fluid.
• Laparoscopy or Laparotomy:
• Purpose: To directly visualize the abdominal cavity and obtain tissue samples if non-invasive methods are inconclusive.
• Procedure:
  • Laparoscopy: A minimally invasive procedure using a small camera inserted through small incisions.
  • Laparotomy: An open surgical procedure involving a larger incision to directly access the abdominal cavity.

5. Differential Diagnosis:

• Purpose: To rule out other conditions with similar symptoms, such as appendicitis, diverticulitis, inflammatory bowel disease, or abdominal trauma.

Summary:

The diagnosis of peritonitis involves a combination of a detailed medical history, physical examination, laboratory tests, and imaging studies. In some cases, invasive procedures like paracentesis or laparotomy may be necessary for definitive diagnosis. Identifying the underlying cause and extent of peritonitis is crucial for determining the appropriate treatment and managing the condition effectively. If peritonitis is suspected, prompt medical evaluation is essential.

What is the treatment for peritonitis?

The treatment for peritonitis typically involves a combination of medical, surgical, and supportive measures, depending on the underlying cause and severity of the condition. Here’s a comprehensive overview of the treatment options:

1. Medical Treatment:

• Antibiotics:
• Purpose: To treat or prevent bacterial infections.
• Regimen: Broad-spectrum antibiotics are often administered initially, and the regimen may be adjusted based on culture results and sensitivity tests.
• Antifungal Medications:
• Purpose: For fungal peritonitis, particularly in immunocompromised patients.
• Regimen: Specific antifungal agents are used based on the identified pathogen.
• Supportive Care:
• Fluid and Electrolyte Management: To address dehydration and maintain electrolyte balance, especially if there is significant fluid loss or vomiting.
• Pain Management: Medications are used to alleviate abdominal pain and discomfort.

2. Surgical Treatment:

• Source Control:
• Purpose: To address the underlying cause of peritonitis, such as infection, perforation, or obstruction.
• Procedure: Depending on the cause, this may involve:
  • Appendectomy: If the source is appendicitis.
  • Perforation Repair: Surgery to repair a perforated ulcer or bowel.
  • Resection: Removal of affected parts of the intestine or other organs if necessary.
• Debridement and Drainage:
• Purpose: To remove infected or necrotic tissue and drain any abscesses or fluid collections.
• Procedure: May be performed during open surgery or using minimally invasive techniques.

3. Peritoneal Dialysis:

• Purpose: For patients undergoing peritoneal dialysis, treatment of peritonitis may include:
• Antibiotic Infusion: Antibiotics are added to the dialysis fluid.
• Dialysis Fluid Exchange: Frequent exchange of dialysis fluid to remove bacteria and toxins.

4. Nutritional Support:

• Purpose: To ensure adequate nutrition and support overall health, especially if the patient is unable to eat normally.
• Options:
• Oral Nutrition: If the patient can tolerate it.
• Parenteral Nutrition: If the patient cannot eat and requires nutrition through an intravenous line.

5. Monitoring and Follow-Up:

• Purpose: To monitor the response to treatment, detect any complications, and adjust the treatment plan as needed.
• Includes: Regular follow-up visits, laboratory tests, and imaging studies to assess progress and recovery.

6. Palliative Care:

• Purpose: For patients with severe or advanced peritonitis where curative treatment is not possible.
• Includes: Symptom management, pain relief, and support for quality of life.

Summary:

The treatment of peritonitis is multifaceted and depends on the cause, severity, and overall health of the patient. It often involves antibiotics or antifungal medications, surgical intervention to address the underlying issue, and supportive care to manage symptoms and maintain overall health. Peritoneal dialysis may be adjusted for patients undergoing this treatment. Monitoring and follow-up are crucial for ensuring recovery and managing complications. Prompt medical attention and a tailored treatment approach are essential for effective management of peritonitis.