What Is Peritonitis? Types, Causes, Signs, Symptoms & Treatment

Peritonitis facts

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The signs and symptoms of peritonitis may vary depending upon the cause of the inflammation; however, there are relatively common indicators that suggest a person may have peritonitis.

• The definition of peritonitis is an inflammation of the peritoneal membranes.
• The signs and symptoms of peritonitis are mainly abdominal pain or discomfort but may include many others such as
  • bloating,
  • nausea,
  • vomiting,
  • fever,
  • diarrhea,
  • decreased urine output, and
  • others.
• The causes of peritonitis are usually infectious bacteria that may include underlying conditions such as
  • abdominal ascites,
  • stomach ulcers,
  • pelvic inflammatory disease (PID),
  • appendicitis, and
  • many others.
• The most common type of peritonitis is secondary peritonitis caused by perforation of an organ in the abdomen (for example, abdominal perforation by stabbing, ruptured appendix, and many others); spontaneous bacterial peritonitis (SBP) seen in patients with cirrhosis, also is relatively common.
• Peritonitis may be treated by many different specialists depending upon its underlying cause.
• Peritonitis is diagnosed by the patient's history, physical exam, and examination of fluid and the abdominal cavity for microorganisms. Ultrasound and CT scan of the abdomen also may be ordered.
• The treatment for peritonitis usually involves treating the underlying cause and removing the cause of the inflammation. Most patients with peritonitis are treated with antibiotics.
• The complications of peritonitis may include sepsis, dehydration, hepatic encephalopathy, shock, and even death.
• Peritonitis can be prevented by eliminating the underlying causes and, in some individuals, by antibiotic therapy.
• The prognosis for a person with peritonitis depends on its underlying cause and/or how rapidly the patient is effectively treated, especially for infectious bacteria. The prognosis may range from good (appendicitis, for example) to poor (hepatorenal syndrome).

What is peritonitis?

The definition of peritonitis is as follows: inflammation of the peritoneum
(the thin layer of tissue covering the inside of the abdomen and various organs
within the abdomen). Peritonitis usually develops from a bacterial or less
frequently, fungal infection; but there are other less often encountered causes
of peritoneal inflammation.

Most individuals need quick or emergent treatment of
peritonitis due to infection because infecting organisms can spread rapidly in
individuals and become life-threatening.

Peritonitis Symptoms & Signs

Peritonitis is an inflammation of the peritoneum, or the lining tissues of the abdomen.

Signs and symptoms of peritonitis are mainly abdominal pain and tenderness. Other associated signs and symptoms can include

• abdominal distension,
• bloating,
• nausea,
• vomiting,
• fever,
• chills, or
• loss of appetite.

Read more about peritonitis symptoms and signs »

What are the signs and symptoms of peritonitis?

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Abdominal tenderness or pain that increases when the abdomen is touched or moved (palpation). Source: iStock

The signs and symptoms of peritonitis may vary depending upon the cause of the inflammation; however, there are relatively common indicators that suggest a person may have peritonitis. People usually have abdominal discomfort and one or more of the following:

1. Abdominal tenderness or pain
2. Abdominal tenderness or pain that increases when the abdomen is touched or moved (palpation)
3. Abdominal swelling (bloating or distention)
4. Fever
5. Chills
6. Nausea
7. Vomiting
8. Diarrhea
9. Decreased urination
10. Loss of appetite (anorexia)
11. Fatigue and/or weakness
12. Constipation
13. Inability to pass gas
14. Ascites (fluid in the abdominal cavity)
15. Unexplained encephalopathy (new-onset mental changes)

What are the causes of peritonitis?

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The causes of peritonitis can be grouped into five categories. The following is a list of these five categories and some examples of their causes:

1. Primary peritonitis: Spontaneous bacterial peritonitis (SBP) is associated with ascites from patients with cirrhosis (highest risk patients for SBP), heart failure, or patients with systemic lupus and nephrosis. The majority of the cases are caused by a microbial infection.
2. Secondary peritonitis: Secondary peritonitis is caused by infection due to a perforated appendix, perforated ulcers, diverticulitis, or bowel strangulation.
3. Tertiary peritonitis: Tertiary peritonitis is caused by the bacterium Mycobacterium tuberculosis (TB), and is referred to as tuberculosis peritonitis.
4. Chemical peritonitis (also termed sterile peritonitis): Chemical peritonitis is caused by leakage of sterile fluids that are irritants to the peritoneum; for example, bile, blood, or barium used as a contrast agent during procedures and tests.
5. Peritoneal abscess: Peritoneal abscess is caused by an infected fluid collection that is encapsulated and/or adjacent to visceral organs and/or the peritoneum.

Some health-care professionals choose not to categorize peritonitis; they simply use a modifier placed in front of or behind the term "peritonitis" to describe the patient's disease. Below are definitions of a sampling of some of these terms:

1. Bacterial peritonitis: any type of peritonitis including spontaneous bacterial peritonitis caused by a bacterial species.
2. Peritonitis appendicitis: peritonitis caused by leakage of the intestinal contents from the appendix.
3. Acute peritonitis: initial rapid onset of peritonitis symptoms.
4. Meconium peritonitis: fetal stool that escapes from fetal bowel before birth by rupture and results in sterile peritonitis.
5. Bile peritonitis: leakage of bile fluid into the peritoneum.
6. Septic peritonitis: infection of the peritoneum that has spread to the blood.
7. Sclerosing peritonitis: inflammation of the visceral and parental surfaces of the abdominal cavity characterized by fibrous thickening of the peritoneum.
8. Pelvic peritonitis: inflammation involving the peritoneum surrounding the uterus and Fallopian tubes.
9. Tuberculosis peritonitis: inflammation of the peritoneum by Mycobacterium bacteria.
10. Ascites peritonitis: infection of ascites fluid causing inflammation of the peritoneum.
11. Peritonitis sintomas: Spanish for peritonitis symptoms.

What is the most common type of peritonitis?

• The most common type of peritonitis is secondary peritonitis, usually caused by leakage or perforation of an abdominal organ, like the appendix.
• However, another common type of peritonitis is spontaneous bacterial peritonitis (SBP) that is most often associated with individuals that have abdominal ascites fluid.

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What kind of doctor treats peritonitis?

Peritonitis can rapidly develop into a life-threatening problem. Depending on
its cause many different doctors will be involved in the treatment;
consequently, peritonitis is seen and treated by
emergency medicine doctors,
critical-care specialists, dialysis specialists, infectious disease specialists,
gastroenterologists, hospitalists, internal medicine specialists, and
surgeons. Other specialists may need to treat underlying causes.

How is peritonitis diagnosed?

Because peritonitis can be life-threatening, early diagnosis is important. Health-care professionals will take a history and perform a physical exam on the patient. They also may ask for details about dialysis, ascites, and trauma to the abdomen. The patient may have some mild discomfort while the doctor examines his/her abdomen.

Tests that may be ordered include a complete cell count (CBC), blood cultures, and imaging tests such as an ultrasound or CT scan of the abdomen/pelvis.

Some patients that do peritoneal dialysis will be asked for a sample of the dialysis fluid so that it can be examined. In some patients with abscesses, examination of the abscess fluid is done.

What is the treatment for peritonitis?

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The treatment for peritonitis begins with correction of the underlying process (for example, appendicitis that has caused peritonitis or bile leakage into the abdominal cavity). In most people with peritonitis, there is an infectious source so intravenous antibiotic therapy is started immediately.

The patient also is likely to require supportive care such as avoiding dehydration, avoiding pulmonary infections that are secondary to peritonitis, and possibly renal system support (especially in patients undergoing dialysis).

Reducing the inflammatory response also may be part of supportive treatment.

Some individuals may require percutaneous abscess drainage to augment antimicrobial therapy. Although there are specific suggestions for antimicrobial therapy for treating infectious peritonitis, optimal antimicrobial therapy should be individualized and depends on the types of infecting organisms and their sensitivity to antimicrobials.

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What are the complications of peritonitis?

The complications of peritonitis can be extremely serious, and include

• dehydration,
• sepsis,
• multiple organ infection and/or failure,
• hepatic encephalopathy,
• hepatorenal syndrome (liver disease leading to increasing
  renal failure),
• shock,
  and
• death.

Can peritonitis be prevented?

• Prevention or reduction in the chance of developing peritonitis can be done by preventing underlying causes (for example, trauma, ulcers, alcoholic cirrhosis, and pelvic inflammatory disease).
• Individuals that are obtaining peritoneal dialysis should be very careful about hand and fingernail cleanliness to avoid contamination to the dialysis catheter. Skin adjacent to the dialysis catheter should be cleaned daily, and patients should follow instructions given to them by their dialysis team.
• Preventive use of antimicrobials have been used to reduce the risk peritonitis; however, if this technique is used, it may generate antibiotic resistant organisms over time.
• Individuals should discuss how to decrease or prevent the likelihood of peritonitis recurrence with their health-care professional.

What is the prognosis for a person with peritonitis?

The prognosis for individuals who develop peritonitis depends on both the underlying cause and how rapidly the disease is treated. The prognosis can range from good to poor. For example, individuals that are treated appropriately with antimicrobials and surgery for peritonitis caused by appendicitis often have a good outcome. However, individuals with long-standing diseases such as liver failure that develop hepatorenal syndrome and peritonitis have a poor prognosis.