What is Peritonitis?

There is a thin layer of tissue that lines your inner abdominal wall and covers most of your abdominal organs. This silky membrane is called the peritoneum. When the peritoneum becomes inflamed, it causes a life-threatening condition called peritonitis. Peritonitis is any inflammation of the peritoneum (the lining of the abdomen) typically due to a fungal or bacterial infection. There are two types of peritonitis: Spontaneous bacterial peritonitis and secondary peritonitis. Spontaneous bacterial peritonitis is caused by an infection of the fluid in the peritoneal cavity, often due to kidney or liver failure, which spreads to the tissue of the peritoneum. Secondary peritonitis is caused when an infection from another part of the body, typically the digestive tract, spreads into the peritoneum.

While the early symptoms of peritonitis can mimic common and less severe abdominal issues, peritonitis requires prompt medical treatment to stop the infection from spreading. The infection can become life-threatening when it spreads to your bloodstream (bacteremia) or throughout the rest of your body (sepsis). When the quick-spreading infection is left unchecked, it can result in severe complications and even death. So it is vital to seek immediate medical attention if you experience the symptoms of peritonitis.

Symptoms of Peritonitis

The symptoms of peritonitis often begin like many other common abdominal issues. First symptoms may include things like abdominal pain or tenderness, bloating, and loss of appetite. However, the symptoms typically worsen quickly and intense abdominal pain is accompanied by fever and chills, excessive thirst, low urine output, fatigue, nausea and/or vomiting, and an inability to pass stool or gas. 

These symptoms are an indication of inflammation and infection and require prompt medical attention. It is important to fight the infection right away, as well as to treat the underlying cause or medical condition. Without treatment, peritonitis can spread very quickly and cause serious, even fatal, complications.

If you are on peritoneal dialysis, a common treatment for kidney failure, symptoms of peritonitis may include dialysis fluid that is cloudy or contains white flecks, clumps, or strands. The dialysis fluid may also develop an unusual and unpleasant odor. Watch for a red area around the catheter tube that may become painful. These symptoms are also signs of infection, and you should contact your doctor immediately.

What Causes Peritonitis?

The two different types of peritonitis have different underlying causes. Primary spontaneous peritonitis occurs when an infection develops in the peritoneum or lining of the abdominal wall. The most common causes are liver and kidney failure. Liver cirrhosis typically causes a buildup of fluid in the abdominal cavity which becomes infected and infects the peritoneum. Kidney failure is often treated with dialysis which can involve the placement of a catheter into the peritoneum to remove waste products. Infection can occur when the peritoneum is accidentally contaminated through the use of the catheter during dialysis. While peritonitis is often thought of as a potential complication from peritoneal dialysis, it is increasingly uncommon. Advances in technology as well as increased training about self-care techniques have dramatically decreased the occurrence of peritonitis related to dialysis.

Secondary peritonitis occurs when an infection reaches the peritoneum due to an injury or the spread of an infection from the abdominal cavity or digestive tract. Common conditions that lead to peritonitis include a ruptured appendix, stomach ulcer, perforated colon, or other abdominal injuries, wounds, or trauma. Medical conditions like diverticulitis, pancreatitis, Crohn’s disease, and pelvic inflammatory disease can also lead to peritonitis. Other causes include invasive medical procedures that can cause infection such as the use of a feeding tube, catheter, or surgery. Complications from procedures like colonoscopy and endoscopy very rarely result in peritonitis.

Diagnosis of Peritonitis

The possible causes and risk factors associated with peritonitis are very important for diagnosis, so your doctor will talk with you about your medical history and any recent injuries, illnesses, and events. A complete physical examination will also help your doctor determine the source and cause of your symptoms. It’s important to share complete information with your doctor or an emergency medical professional. Peritonitis may be relatively easy for your doctor to diagnose if you are undergoing peritoneal dialysis and the fluid is cloudy. But other causes and symptoms may take more diagnostic work. 

Blood tests can indicate infection and the presence of bacteria in the blood. Imaging tests like an X-ray or CT Scan may be ordered to look at the condition of your internal organs and gastrointestinal tract, particularly looking for any perforations or holes. Paracentesis, where a thin needle is used to extract peritoneal fluid, may be used in order to perform a fluid analysis that can indicate infection or bacteria in the peritoneal fluid.

Treatment for Peritonitis

The good news is that this potentially life-threatening condition can often be treated with antibiotics which are typically administered through an IV. The type of antibiotic used, as well as the duration of the course of antibiotics, will be determined based on the type of peritonitis and how severe it is. Because the risk for the spread of infection is high, you will likely be admitted to the hospital when diagnosed with peritonitis, and given treatment there. Antibiotics will help to fight the infection and also help prevent peritonitis from spreading. Sometimes, depending on the cause, peritonitis requires surgery. Infected or damaged tissue may need to be removed, or an internal injury may need to be repaired. 

Surgery is common in cases of peritonitis that involve a perforation in the colon or stomach, or a ruptured appendix. Depending on your condition and the procedures required to treat it, you may need to have additional medical treatments including things like IV fluids, pain medications, and even blood transfusions. Your doctor and hospital care team will determine the best course of treatment to stop peritonitis and restore you to health. If you are in the midst of dialysis treatment, it will most often have to be stopped until the infection is gone.

Can Peritonitis be Prevented?

Not all causes of peritonitis can be prevented—you cannot control things like the occurrence of injury due to trauma or a ruptured appendix. However, you can lower your risk of most diseases and medical complications by following a healthy diet and exercise routine to keep your body in overall good health. You can also lower the risk of peritonitis by using good hygiene during and after any medical procedure. If you have a catheter, be sure to wash your hands well before touching the catheter, and keep the area around it clean with antiseptic. It’s also a good idea to apply antibiotic cream once a day to the site. Keep any post-surgery supplies in a sanitary place. You should always take antibiotics or other medications prescribed by your doctor. Seek medical attention immediately if you develop new abdominal pain, have an abdominal injury, or experience any of the symptoms of peritonitis. Prompt treatment can help to stop the spread of infection and prevent serious complications. If you are experiencing severe abdominal pain or other serious symptoms of peritonitis, visit your closest emergency department or call 911. 

If you need more information about stomach pain or have questions or concerns about your overall gastrointestinal health, request an appointment at GI Associates and Endoscopy Center today. All of the doctors and staff at GI Associates’ three convenient locations are committed to your overall health, comfort, and well-being. Contact us today to learn more.

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