The peritoneum is the membrane that lines the abdominal cavity and covers organs. When it becomes inflamed, the disease is called peritonitis.
This condition can be confused with intraabdominal abscess
abscess), which involves a collection of pus
in the abdomen
that may cause
peritonitis. Before peritonitis develops, it can still cause symptoms that are similar or identical to peritonitis.
There are three main types of peritonitis: spontaneous, secondary, and peritonitis associated with dialysis
Causes and Development
Also known as spontaneous bacterial
peritonitis, spontaneous peritonitis
is an infection that occurs as a complication of ascites
(a collection of fluid in the peritoneal cavity
). Most cases of bacterial peritonitis occur as a result of ascites due to chronic liver
disease, or in kidney failure
patients undergoing peritoneal dialysis
. In the latter case, the cause of spontaneous peritonitis is infection in the blood that spreads to the peritoneal fluid, usually from a contaminated peritoneal dialysis catheter.
Risk factors for liver disease include alcoholic cirrhosis
and other diseases that lead to cirrhosis, such as viral hepatitis
. Patients with kidney failure can develop nephrotic syndrome, which leads to ascites
and can then become infected.Secondary peritonitis
is secondary to (caused by) another condition, most commonly the spread of an infection from the digestive organs or bowels. Bacteria
may enter the peritoneum
via a hole in the gastrointestinal
tract, which can be caused by a ruptured appendix, stomach ulcer
or perforated colon
. The condition can also occur when pancreatic
enzymes leak into the peritoneum during pancreatitis
or when bile
leaks from the biliary tract due to injury because these chemicals can irritate the peritoneum. Foreign contaminants can also cause secondary peritonitis if they get into the peritoneal cavity
. This can occur during use of peritoneal dialysis catheters.Peritonitis associated with dialysis
(PAD) is an acute or chronic inflammation
(irritation and swelling) of the peritoneum (lining of the abdomenal cavity) that occurs in people receiving peritoneal dialysis. The cause of dialysis-associated peritonitis may be the introduction of bacteria into the peritoneum by the dialysis procedure. Skin bacteria are the most common organisms causing infection. Incidence is about one infection for every 15 months of peritoneal dialysis.
Signs and Symptoms
(General) signs and symptoms include:
Additional symptoms that may be associated with this disease include cloudy dialysis
fluid (if undergoing peritoneal
dialysis); nausea and vomiting; shaking chills; signs of shock.
Specific signs and symptoms of spontaneous peritonitis
include: Fluid in the abdomen; abdominal pain and distention; tenderness; decreased bowel sounds; inability to pass feces or gas; fever; thirst; low urine output, nausea and vomiting, joint pain, chills.
Signs and symptoms of secondary peritonitis
include: Abdominal pain; abdominal distention; fever; thirst; low urine output. There may also be signs of shock.
Signs and symptoms of PAD
include abdominal tenderness; distended abdomen; nausea and vomiting; cloudy dialysis fluid; fever; chills.
Diagnosis and Tests
- Ascitic fluid – turbid, bloody, may contain fat globules; increased WBC; Gram's stain and aerobic and anaerobic cultures show multiple organisms; increased amylase; increased mononuclear cells and decreased glucose occur in tuberculous peritonitis
- Leukocytosis – up to 50,000/ul with 80-90% neutrophils; may not occur in older patients
- Increased haemoglobin, haematocrit, and BUN – reflect haemoconcentration secondary to extracellular fluid loss into the peritoneal cavity
- Laboratory findings of any of the underlying conditions.
Treatment and Prevention
Treatment of spontaneous peritonitis
depends on the cause; surgery may be needed in cases where peritonitis is asociated with a foreign object, such as a peritoneal dialysis
catheter. Antibiotics are administered to control infection in cases of spontaneous peritonitis in patients with liver
disease, and dehydration is treated by intravenous therapy. Hospitalization is common and may be necessary to rule out other causes of peritonitis such as appendicitis and diverticulitis
Surgical treatment of secondary peritonitis
is usually necessary to remove sources of infection such as infected bowel, inflamed
appendix, or an abscess
. General treatment includes intravenous fluids, antibiotics, and use of medications to treat pain.
The goal of treatment in PAD
cases is to cure the infection. Antibiotics are given into a vein (intravenous injection) and/or into the peritoneum
. The antibiotic will be specific to the organism recovered in cultures of blood or peritoneal fluid.
The infection can usually be treated, but the prognosis for spontaneous peritonitis
patients may be poor because of underlying kidney
disease. People with these conditions often respond to antibiotics but may still have a poor outcome.
The outcome of secondary peritonitis
depends on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Outcomes can range from complete recovery to overwhelming infection and death, depending on these factors.
patients recover completely.
Complications of spontaneous peritonitis
may include abscess
development; intestinal obstruction from scar tissue
; hepatorenal syndrome; hepatic
encephalopathy; massive sepsis
of peritoneal cavity
caused by bacteria
can result in infection of the bloodstream – sepsis – and severe illness.)
Possible complications of secondary peritonitis
include septic shock, abscess or intraperitoneal
complications can include recurrent peritonitis, intraabdominal abscess, catheter tract infection (removal of the dialysis
catheter may be necessary.)