Peritonitis - Symptoms, Causes, and Treatment

Introduction:

Inflammation of the tissue that lines the inner wall of the abdomen (peritoneum) is called peritonitis. The peritoneum is known to cover and support most of the organs in the abdominal cavity. The inflammation can be due to bacterial or fungal manifestations. The most common symptom of peritonitis is severe pain in the abdomen which should be immediately reported to medical professionals to seek help and prevent some potentially fatal complications. If it is left untreated, it can be spread rapidly into the blood and other vital organs, which can lead to multiple organ failures and death.

What Are the Symptoms of Peritonitis?

Initially, peritonitis shows poor or loss of appetite and nausea (uneasiness in the stomach, often felt before vomiting), and mild abdominal pain. Gradually the symptoms turn to persistent severe abdominal pain, which has the potential to worsen by any movement.

Other than these symptoms, peritonitis may also show the following symptoms -

• Chills: A sudden feeling of cold felt by the body.

• Fever: Increase in body temperature.

• Abdominal Tenderness: Pain felt in the abdomen area when even little pressure is applied.

• Fluid in the abdomen - Ascites.

• Less urination or no urine is passed from the body.

• Troubled bowel movements or difficulty in passing gas.

• Vomiting.

• Peritonitis can result in fatal complications such as sepsis (infection in the blood), further leading to septic shock. Shock can cause a massive drop in blood pressure, organ failure, and eventually death.

How Is Peritonitis Caused?

Peritonitis can be caused due to different factors, and depending on those, it is classified into the following types.

1. Primary Peritonitis: It is spontaneous in nature. This type of infection develops itself in the peritoneum. Risk factors of primary peritonitis are -

• Kidney failure cases treated with peritoneal dialysis: In this technique, implantation of the catheter is done into the peritoneum, used to remove waste products from the blood as the kidneys are unable to filter blood. This technique makes the body more susceptible to peritonitis as there can be any accidental contamination of the peritoneum by the catheter.

• Liver disease with cirrhosis: cirrhosis can cause accumulation of abdominal fluid (ascites) which can become infected and eventually lead to inflammation of the peritoneum.

2. Secondary Peritonitis: This type of peritonitis develops from an injury or abdominal infection, allowing the infectious organism to invade the peritoneum. Approximately 10 % of patients die due to secondary peritonitis.

Causes of secondary peritonitis are:

• Crohn’s disease - Is a digestive disorder that causes inflammation in any part of the digestive system more frequently, the small intestine and colon are affected. Crohn's disease is generally chronic in nature.

• Diverticulitis - Diverticula are pouches that can form in the intestines, which are generally not harmful. Inflammation of these pouches is called diverticulitis.

• A ruptured appendix, diverticulum, or stomach ulcer can cause invasion of infective microorganisms into the peritoneum and then causes peritonitis.

• Inflammatory diseases of the pelvis.

• Any perforation or penetration in the stomach lining, intestine, appendix, or gallbladder can cause peritonitis.

• Surgery in any part of the abdomen region.

• Any trauma to the abdomen, such as a gunshot wound or knife stab.

3. Tertiary Peritonitis is a less well-defined entity that occurs after operative attempts to treat secondary peritonitis. It is exclusively associated with a systemic inflammatory response of the body.

Peritonitis can also be classified as local or diffuse depending on clinical characteristics. Local peritonitis is specific to its location, whereas diffuse peritonitis infects the entire body. All types of peritonitis are lethal. The death rates are higher (as high as almost 40 %) in cirrhosis patients.

How to Diagnose Peritonitis?

A potentially lethal disease, peritonitis, needs a quick diagnosis and correct treatment. Different measures to diagnose peritonitis are,

• Blood and Urine Test : Helps to investigate the presence of bacteria or fungal organisms which can cause peritonitis.

• X-rays and CT (computed tomography) scans are used to look for any perforations or inflammations in the abdomen.

• Exploratory surgery.

• Paracentesis : A diagnostic procedure in which fluid from the abdominal cavity is withdrawn through a thin needle. The fluid is investigated for any infection. This method is useful in cases of peritonitis due to pancreatitis (inflammation of the pancreas).

What Is the Treatment of Peritonitis?

• After diagnosis, the person is hospitalized, and intravenous antibiotics or antifungal medication are injected to cure the infection.

• In cases of organ failure from septic shock- Intravenous fluids, nutritional support, and medications for blood pressure are administered.

• If peritonitis is associated with peritoneal dialysis, drugs are injected directly into the peritoneum space as it is considered more effective than intravenous.

• In conditions such as appendicitis, diverticulitis, or perforated stomach ulcer, emergency surgery is required. Removal of infected tissue along with part of peritoneum has been damaged.

What Factors Affect the Prognosis of Peritonitis?

• Age of the Patient -The younger population has a better prognosis than the older population.

• Metabolic Acidosis - Increase in the concentration of acid in the body resulting in an imbalance in acid-base levels.

• Fecal Peritonitis - A condition in which the peritoneum lining is affected by fecal matter.

• Blood Pressure Levels - Increase in blood pressure affects the treatment of peritonitis.

• Serum Albumin Levels - Peritonitis leads to a decrease in serum albumin levels.

• Pre-operative Organ Failure - Manifestation of infection in the blood can lead to sepsis and organ failures.

How to Prevent Peritonitis?

Different types of causes of peritonitis can be prevented by the following measures:

• In some cases of cirrhosis and ascites, doctors can prescribe antibiotics as a prophylaxis to prevent peritonitis.

• Though cases of infection in peritoneal dialysis are reduced, the following tips can still be used to lower the risk-

1. Wearing a mouth or nose mask during dialysis.

2. Proper washing of hands, the area under the nails, and in between the fingers, before touching the catheter.

3. Adequate sterilization for catheter checked.

4. Application of antibiotic cream on the catheter’s exit site every day.

Conclusion:

Peritonitis is a disorder that can get severe if neglected, but early detection and treatment can cure the disease. The primary reason for the disease is the bacterial or fungal invasion in the peritoneum, which causes inflammation. Peritoneal dialysis in cases of kidney failure is the most common predisposing condition of peritonitis. Depending upon the clinical appearance and causes, it is classified into primary, secondary, and tertiary, which can be treated accordingly. Antibiotics and surgical procedures are major treatment options for peritonitis. Following proper preventive measures can reduce the risk of disease prevalence.