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. 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.
Peritonitis presents with severe generalised abdominal pain, which is worse on movement. Without treatment, the patient can rapidly deteriorate.
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, you must contact your doctor immediately. If this is not possible, you must call an ambulance or visit the Emergency Department of your nearest hospital as soon as possible.
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 inflamed. 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 cirrhosis, can occur due to liver damage. The most
common causes of cirrhosis in the UK 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.
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
- lack of appetite
- chills
- a high temperature (fever)
of 38°C (100.4°F) or above
- rapid heartbeat
- not passing any urine or
passing less than normal
- 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,
you must either call for an ambulance, or visit the Accident and Emergency (A&E) department of your local hospital.
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.
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.
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 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 don't 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.
Source: NHS Choices
Source: NHS Choices