Peritonitis is a condition characterised by inflammation of the peritoneum. The peritoneum is the thin membrane that lines the inner walls of the abdomen and covers many of the internal organs.
Bacterial or fungal infections are the most common causes of peritonitis, usually occurring in cases where the abdominal wall is perforated or compromised. This could be due to underlying conditions (including a burst appendix, peptic ulcer or diverticulosis), gastrointestinal surgery or procedures like peritoneal dialysis, or by trauma to the abdomen – giving these organisms access to invade the peritoneum from elsewhere in the body. This is called secondary peritonitis.
Primary spontaneous peritonitis occurs when no rupture has taken place but fluid in the peritoneum becomes infected. This type of peritonitis can be a complication of liver cirrhosis or kidney failure.
Peritonitis can be fatal, because if the infection spreads to the bloodstream it can lead to sepsis and organ failure.
What are its symptoms?
Peritonitis symptoms include:
- Abdominal pain is the main symptom. Pain is exacerbated with movement and usually starts off as a dull ache that becomes increasingly severe
- Distension of the abdomen or feeling of being bloated
- Vomiting and nausea
- Loss of appetite
- Constipation or problems passing flatulence
- Decreased urine output
- Excessive thirst
How is it diagnosed?
As peritonitis can be fatal, it is vital that diagnosis of peritonitis occurs swiftly, meaning that if based on symptoms, a physical examination and medical history, peritonitis is strongly suspected, medical professionals may opt to progress straight to treatment rather than carrying out further testing.
If a diagnosis needs to be confirmed, blood tests can look for signs of infection, while imaging tests like X-ray and ultrasound may be able to pick up perforations in the abdominal wall. Clinical testing of a peritoneal fluid sample can also reveal whether bacteria are present.
What are your treatment options?
Peritonitis treatment focuses on eradicating the underlying infection before further complications set in, usually via intravenous antibiotics or antifungal medication.
Emergency surgery may also be necessary to repair any ruptures of the peritoneum that led to peritonitis and, in cases where infected tissue has become badly damaged, to remove it.
If peritonitis is linked to peritoneal dialysis, the patient may have to receive dialysis via a different method until the infection has cleared. In these cases, it may also be deemed beneficial to inject antibiotics straight into the peritoneum rather than administering them intravenously.
Can it be prevented?
You can reduce your risk of developing primary spontaneous peritonitis related to peritoneal dialysis by taking steps to minimise bacteria around your catheter. These include always washing your hands properly before handling the catheter, cleaning the skin around it daily and keeping your medical supplies stored sanitarily.
Prevention of secondary peritonitis relies on the swift treatment of any abdominal trauma or underlying treatment that could put you at risk. Treat severe abdominal pain as a medical emergency, especially if it is so bad that you are unable to get comfortable or sit still.
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