Peritonitis is
inflammation of the peritoneum, the thin layer of tissue that
lines the inside of the abdomen (tummy). It is caused by an infection,
which can rapidly spread around the body. Peritonitis is
regarded a medical emergency and requires immediate treatment.
Symptoms and signs of peritonitis often
develop quickly and can include:
- sudden abdominal pain that becomes more severe
- nausea (feeling sick)
- a lack of appetite
- a high temperature (fever) of 38°C (100.4°F) or above
- not passing any urine or passing less than normal
Sudden abdominal
pain that gradually gets worse is usually a sign of a potentially serious
infection or illness. If you experience this kind of pain, contact your
doctor immediately. If this is not possible, call your local out-of-hours
health service, or go to your nearest Accident and Emergency (A&E)
department.
Peritonitis is caused by a
bacterial or fungal infection that either develops directly in the peritoneum
or spreads from another part of the body.
Most cases of peritonitis are the
result of infection or injury to another part of the body, such as:
- a split stomach ulcer
- a burst appendix
- digestive disorders, such as Crohn's disease or diverticulitis.
Less commonly, an
infection develops directly within the peritoneum due to:
- cirrhosis - scarring of the liver caused by long-term liver damage
- peritoneal dialysis - a widely used treatment for people with kidney failure
Peritonitis is a
serious condition that needs to be diagnosed and treated quickly to
prevent possibly fatal complications developing,
so you will usually be admitted to hospital for tests and treatment. The
underlying infection will be treated with
injections of antibiotics or antifungal
medication, depending on the cause of the infection. In some cases,
surgery may be required to repair damage to the peritoneum or to treat the
underlying cause of the infection.
Peritonitis can be
fatal, despite the best efforts of medical staff. This is often due to the
infection spreading through the bloodstream to the major organs (septic shock).
It is estimated that
about 1 in every 10 people with peritonitis due to
bowel perforation (a hole that develops in the bowel wall) will die, although
this can vary considerably depending on what caused the condition, your age,
and your general health. Deaths are less common for peritonitis related
to cirrhosis or kidney dialysis, but it is still a serious condition.
Causes of
Peritonitis
Peritonitis occurs
when the peritoneum becomes infected with bacteria or fungi. The
peritoneum is the thin layer of tissue lining the inside of the
abdomen (tummy). The infection can either develop directly in the
peritoneum or it can spread from another part of the body.
Most often, peritonitis is caused by an
infection that spreads to the peritoneum from another part of the body. This is
known as secondary peritonitis. Common causes of
secondary peritonitis include:
- a split stomach ulcer
- a burst appendix
- acute pancreatitis (inflammation of the pancreas)
- severe trauma to the abdomen, such as a knife or gunshot wound
- digestive disorders, such as Crohn's disease or diverticulitis.
Both Crohn’s disease
and diverticulitis can cause the colon to become inflammed. If the
inflammation is particularly severe, the colon can split and leak the contents
of the bowel onto the peritoneum, contaminating it with bacteria.
Less commonly, peritonitis occurs
when the peritoneum becomes directly infected. This is known as primary or
spontaneous peritonitis.
In most cases,
primary peritonitis is
caused by scarring of the liver or peritoneal dialysis.
Scarring of the
liver, known as liver cirrhosis, can occur due to liver damage. The
most common causes of cirrhosis in the USA, UK and other Western societies,
are alcohol misuse, a hepatitis C infection or obesity.
Cirrhosis can lead
to a build-up of fluid inside the abdomen (known as ascites). This fluid
is particularly vulnerable to infection and provides an environment where
bacteria or fungi can grow and spread. This build-up of fluid affects
around half of people with cirrhosis, usually many years after cirrhosis was
diagnosed. About 20% of people with cirrhosis who develop ascites
will be affected by peritonitis.
People
with kidney failure who are having a treatment known as peritoneal
dialysis are at risk of developing peritonitis. Dialysis is
a medical treatment that replicates the main functions of the kidneys and
removes waste products from the body.
Peritoneal dialysis
involves using the peritoneum to replicate the main function of the kidneys,
which is to filter waste products out of the blood. A small tube, called a
catheter, is implanted into the blood vessels of the peritoneum and waste
products are removed through the catheter.
Although uncommon, peritonitis can
occur if the equipment becomes contaminated by bacteria or fungi.
Complications of
Peritonitis
Serious complications of peritonitis can
occur if the infection spreads to other parts of the body. You will
usually be admitted to hospital if you are diagnosed with peritonitis, so any
problems can be identified and treated as quickly as possible.
Sepsis can occur if the infection
spreads through the blood (septicaemia) and then to other organs. If sepsis is not treated, it can progress
to a more serious phase known as severe sepsis. Severe sepsis occurs when one or more organs are
damaged by the infection, or when there is a significant loss of blood supply
to tissues and organs.
The symptoms of sepsis usually develop quickly and
include:
- a fever or high temperature over 38C (100.4F)
- chills
- a fast heartbeat
- fast breathing
Treatment for sepsis involves intravenous fluid
therapy (fluids into a vein) and antibiotic injections. If sepsis is not treated promptly, it can
develop into septic shock.
Septic shock is a
type of sepsis that causes
a massive drop in blood pressure. This leads to symptoms of shock such as cold
skin and an increased heartbeat. Sepsis can interfere with many of the body’s
vital processes, including blood pressure, breathing and organ function, and
can result in death.
Treatment usually
requires admission to an Intensive Care Unit (ICU) where the functions of the
body’s organs will be supported while the infection is treated.
Symptoms of
Peritonitis
Abdominal (tummy)
pain is one of the main symptoms of peritonitis. This
usually begins as a sudden ache that progresses to a severe pain.
Other possible symptoms include:
- nausea (feeling sick)
- vomiting (being sick)
- lack of appetite
- chills
- a high temperature (fever) of 38°C (100.4°F) or above
- raised heart rate (rapid heartbeat)
- not passing any urine or passing less than normal
- abdominal distension (swelling of the abdomen).
If you are being
treated with peritoneal dialysis because you have kidney failure, the
fluid that is passed into your collection bag will probably be cloudier than
usual and it may contain white flecks or clumps.
If peritonitis is due
to cirrhosis, you may not have any pain at all. You may simply feel generally
unwell or develop other complications of liver disease such as increasing fluid
accumulation in your abdomen or confusion.
When to get medical help
Sudden abdominal
pain that gradually gets worse is usually a sign of a potentially serious
infection or illness. If you experience this type of pain, contact your
doctor immediately. If this is not possible, call your local out-of-hours
health service, or visit your nearest Accident and Emergency (A&E)
department.
Diagnosis of
Peritonitis
Peritonitis can
often be diagnosed after a
physical examination and tests.
Your doctor will ask
you about your symptoms and recent medical history and will carry out a
detailed physical examination.
If you have peritonitis, parts of
the body such as the abdominal (tummy) wall often become very tender to the
touch. A physical examination will help rule out other conditions that can
cause similar symptoms, such as a hernia.
The risk
of complications from peritonitis is
high. Therefore, if your physician suspects that you have it, they will
probably arrange for you to be admitted to hospital immediately for tests.
You may
need blood tests and urine tests to check for infection. If you
have a build-up of fluid in your abdomen (tummy), a small sample may be removed
using a thin needle so it can be checked for signs of infection.
Doctors may also
recommend:
- an X-ray - where radiation is used to produce an image, in order to look for evidence of leakage of air from the bowel
- an ultrasound scan - where sound waves are used to build a picture of the inside of your peritoneum
- a computerised tomography (CT) scan - a series of X-rays are taken to build up a more detailed three-dimensional picture of your peritoneum.
These types of scans
can often detect whether there is internal damage inside your abdomen, such as
a burst appendix, a ruptured stomach ulcer or extensive
inflammation of the colon.
Treatment of
Peritonitis
If you are diagnosed with peritonitis, you will
probably be admitted to hospital so you can be carefully monitored. This
is because of the risk of serious complications of peritonitis, such
as blood poisoning.
The initial treatment for peritonitis involves
injections of antibiotics or
antifungal medication. This will usually last 10 to 14 days. If your peritonitis was caused by
peritoneal dialysis, antibiotics may be
injected directly into the tissue of the peritoneum. Research has shown this is
more effective than injecting antibiotics in a
vein.
You will also need
to use an alternative method of dialysis, such as haemodialysis (where the
blood is passed through a filtering machine) until the peritonitis has
been successfully treated. If peritonitis is
causing pain, you may also be given painkilling medication.
Many people with peritonitis have
problems digesting and processing food, so a nasogastric (NG - through the
nose to the stomach) feeding tube may be needed. The feeding tube is
either passed into your stomach through your nose (nasogastric tube) or
surgically placed into your stomach through your tummy. If these are
unsuitable, nutrition may be given directly into one of your veins (parenteral
nutrition).
If part of the
tissue of the peritoneum has been seriously damaged by infection, it may need
to be surgically removed. Some people develop abscesses (pus-filled swellings) in their
peritoneum that need to be drained with a needle. This is carried out using an
ultrasound scanner to guide the needle to the abscess. Local
anaesthetic is usually used so you do not feel any pain.
The cause of peritonitis may
also need to be surgically treated. For example, if a burst appendix caused
your peritonitis, your appendix will need
to be removed.
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