Peritonitis and Abdominal Sepsis

Introduction:

Peritonitis is caused by a bacterial organism that enters the abdominal cavity through an opening or a hole in the gastrointestinal tract. Peritonitis can proceed to sepsis. They cause stomach pain, nausea, vomiting, fever, etc. Blood tests, urine tests, and specific imaging studies are performed to rule out the disease. And they are often treated with intravenous antibiotic management, and surgery is done to remove the infection.

What Are Peritonitis and Abdominal Sepsis?

The peritoneum is a fine flimsy layer of tissue that lines the abdominal wall. When the peritoneum is inflamed (swollen) due to bacterial infections, there is redness and swelling, which leads to many symptoms and can become life-threatening. In addition, peritonitis can progress to sepsis. Sepsis results from excess tissue injury due to inflammation caused by bacterial invasion and the body’s immune system is suppressed and does not exhibit anti-inflammatory action. Abdominal sepsis is an infection spread to other organs in the abdomen.

Are Peritonitis and Abdominal Sepsis Similar Conditions?

Peritonitis is the inflammation of the peritoneum that lines the abdomen, and abdominal sepsis is the infection that spreads throughout the abdominal organs and enters the blood circulation. Both are different conditions, but the causes are similar. And peritonitis can progress to abdominal sepsis. However, both are life-threatening and sometimes fatal (lead to death).

What Causes Peritonitis and Abdominal Sepsis?

• An opening or a perforation in the internal organs like the colon, gallbladder, uterus, stomach, and bladder. Infection can spread from these organs to the peritoneum through the perforation.

• Stomach ulcers, ruptured appendix, or perforation in the colon can cause the perforation. Perforations can also be mechanical injury due to gunshots, knife injury, or ingesting a sharp-edged object.

• Leakage of chemicals released by the pancreas into the abdominal cavity.

• An infection from dialysis during end-stage kidney disease. Dialysis is a procedure done to remove excess fluid and wastes from the body when the kidney does not function properly.

• Infection of the abdominal fluid due to liver cirrhosis (scarring of healthy liver tissue).

• Inflammatory disease of the pelvis in females.

• The infection spread from surgeries.

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• Feeding tubes and catheters are placed while performing procedures like peritoneal dialysis. Germs are formed around the catheter, leading to infection if not properly managed.

• Pancreatic secretions leakage due to pancreatitis (inflammation of the pancreas).

What Are the Symptoms of Peritonitis and Abdominal Sepsis?

• Severe stomach pain that worsens with movement.

• Nausea and vomiting.

• Fever.

• Reduced appetite.

• Swelling of the abdomen or the belly.

• Bloating.

• Fluid in the belly.

• Unable to pass gas.

• Improper bowel movements.

• Low urinary output.

• Increased thirst.

• Difficulty in breathing.

• Low blood pressure.

• Shock (a condition when the blood flow in the body drops suddenly due to an infection or trauma).

What Tests Are Performed to Find Peritonitis and Abdominal Sepsis?

• Blood Tests: Complete blood count is done to check the normal ranges of the blood parameters like the red blood cells, white blood cells, platelets, hemoglobin, eosinophils, basophils, and neutrophils. An infection can be ruled out if these parameters change in the normal ranges.

• Blood Culture: A blood culture looks for any infectious organisms like bacteria or fungi in the blood.

• Peritoneal Fluid Analysis: A needle is used to remove the fluid sample from the abdomen. If the results indicate an increased white blood cell count, it confirms the presence of an infection or inflammation.

• Urine Tests: Urinalysis checks for any signs of infection or disease.

• X-Ray: A high-frequency radio wave captures images of the targeted organ and surrounding tissues.

• Computed Tomography (CT) Scan: Computed tomography uses high-frequency radio waves to obtain images of the internal organs on a computer screen. It captures images of the internal organs, surrounding tissues, and bony structures.

• Magnetic Resonance Imaging (MRI): Magnetic resonance imaging captures pictures of the internal structures with a high-frequency radio wave in a magnetic field. It produces a clear picture of the internal organ and shows if any abnormalities are present.

How Are Peritonitis and Abdominal Sepsis Treated?

• Antibiotics: Antibiotics are administered intravenously (through veins) to fight against the bacteria and stop the infection from spreading. The type of antibiotic depends on the severity of the infection.

• Surgery: The infected tissue is removed surgically. It prevents the infection from spreading to other organs. A surgical procedure will be considered if the cause of the peritonitis is due to perforations in the stomach, colon, or ruptured appendix.

• Other Treatments: Other treatment methods include administering painkillers and fluid therapy like administering ringer lactate solution or normal saline by injecting through the veins. Blood transfusion is also considered in some cases when the infection is spread into the blood circulation.

What Are the Complications of Abdominal Sepsis and Peritonitis?

• It can progress to sepsis, meaning the infection is spread to other organs in the body through blood circulation as the infectious organism moves into the blood when the immune system is compromised.

• Sepsis can cause shock, a condition where there is a sudden fall in the blood flow, which causes various complications in the body leading to death.

What Are the Risk Factors That Induce Peritonitis and Abdominal Sepsis?

• Peritoneal Dialysis: When the kidney does not function properly, the accumulated fluid and wastes are removed from the body through the peritoneum. Also, it purifies the blood.

• Liver Cirrhosis: The healthy liver tissues are replaced by scar tissues. This hardens the liver and prevents the liver from functioning properly. It, in turn, leads to a build-up of fluid and toxins in the body.

• Appendicitis: The appendix is a finger-like projection from the colon. It is present on the right lower side of the abdomen. When the appendix bursts or ruptures, the bacteria move to the peritoneum resulting in an infection.

• Crohn's Disease: It is an inflammatory bowel disease that affects the lining of the gastrointestinal tract. This long-term inflammation leads to perforations. This paves the way for the entry of bacteria into the peritoneum.

• Stomach Ulcer: Stomach ulcers are sores in the stomach wall lining. Long-term ulcers can cause perforations leading to bacteria entering the abdominal cavity and the peritoneum.

• Pancreatitis: It is the inflammation of the pancreas. The pancreas is a leaf-shaped organ present in the abdomen. It secretes enzymes that help in digestion and also help maintain blood sugar levels. This swelling and inflammation lead to the escape of the pancreatic enzymes into the peritoneum.

• Diverticulitis: It is a condition where tiny, bulgy pouches are formed in the lining of the intestines. They inflame and get infected over time, and this is called diverticulitis. When these inflamed pouches rupture and pour the digestive tract contents into the peritoneum or abdominal cavity, it results in peritonitis.

How to Prevent Peritonitis and Abdominal Sepsis?

Peritonitis is primarily seen in peritoneal dialysis patients.

• Cleaning the skin around the catheter frequently with antiseptics.

• Also, washing hands before touching the catheter will prevent the germs from transferring from the hands.

• Patients with ulcers, appendicitis, and cirrhosis should have regular check-ups with the doctor to prevent complications.

Conclusion:

Peritonitis and abdominal sepsis are severe life-threatening conditions if not treated on time. They are caused by bacterial infections transferred from other abdominal organs through perforations or ruptures. They cause symptoms like severe belly pain, nausea, vomiting, diarrhea, low urine output, etc. And they are diagnosed by performing a certain blood test, fluid analysis, urinalysis, and other imaging techniques. Then they are treated with antibiotics, fluid infusions, and surgery. Though these are life-threatening conditions, immediate medical care and hospitalization will improve the patient's quality of life and prevent complications.