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 (abdominal 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.
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.
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.
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 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.
Most PAD patients recover completely.
Complications of spontaneous peritonitis may include abscess development; intestinal obstruction from scar tissue; hepatorenal syndrome; hepatic encephalopathy; massive sepsis (inflammation 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 adhesions.
PAD complications can include recurrent peritonitis, intraabdominal abscess, catheter tract infection (removal of the dialysis catheter may be necessary.)
Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the sterile abdominal cavity, called the peritoneum. This causes peritonitis, an inflammation of the abdominal cavity and wall. A perforated ulcer usually requires immediate hospitalization and surgery.