Peritonitis

1 What is Peritonitis?

There is a thin layer of tissue that covers the inside of the abdomen and other organs, called the

peritoneum. Inflammation of this silk-like membrane is called peritonitis. It results from complications

due to other medical conditions or a rupture (perforation) in your abdomen caused by a fungal or

bacterial infection.

Peritonitis requires prompt medical attention to fight the infection and treat any underlying medical conditions, as it may lead to severe or even fatal infections if left untreated.

Treatments for peritonitis are antibiotics or surgery. If you are undergoing peritoneal dialysis therapy, good hygiene before, during, and after dialysis must be maintained to prevent peritonitis.

2 Symptoms

The signs and symptoms of peritonitis are:

  • Fever
  • Abdominal tenderness or pain
  • Nausea and vomiting
  • Feeling of fullness (distention) or bloating in your abdomen
  • Diarrhea
  • Loss of appetite
  • Thirst
  • Low urine output
  • Fatigue
  • Inability to pass stool or gas

Peritonitis

If you are undergoing peritoneal dialysis, symptoms may also include:

  • White flecks
  • Clumps (fibrin) or strands in the dialysis fluid
  • Cloudy dialysis fluid

This disease can be fatal, so consult your doctor as soon as possible if you have severe pain in the abdomen that includes any of the above-mentioned symptoms.

Consult your doctor if you have an unusual odor in the catheter or if the fluid is red and painful while you are undergoing peritoneal dialysis.

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3 Causes

One of the causes of peritonitis is a rupture (perforation) in the abdominal wall, which is called spontaneous peritonitis.

The common causes of this rupture include:

  • Medical procedures, such as peritoneal dialysis: Your doctor uses tubes (called catheters) to remove waste products from your blood when your kidneys no longer function. Due to unclean surroundings, contaminated equipment, and poor hygiene an infection could occur during this dialysis. Peritonitis may also develop as a complication of an endoscopy, colonoscopy, gastrointestinal surgery, or paracentesis, which is a procedure that withdraws fluid from your abdomen.
  • Pancreatitis: Inflammation of your pancreas (pancreatitis) after bacteria spreads out due to infection.
  • Stomach ulcer, ruptured appendix, or perforated colon: These can allow bacteria to get inside the peritoneum.
  • Diverticulitis: An infection of the bulging pouches in the digestive tract (diverticulitis) can cause them to rupture, spilling intestinal waste into your abdominal cavity.
  • Trauma: This occurs when chemicals or bacteria enter the peritoneum. Spontaneous peritonitis or abdominal rupture is usually a complication of liver disease, like cirrhosis, and if it is advanced cirrhosis, there will be a large amount of fluid buildup in your abdominal cavity (ascites).

Peritonitis includes two types, spontaneous and secondary.

Spontaneous peritonitis occurs with an infection due to complications of ascites, which is a collection of fluid in the peritoneal cavity that allows fungi or bacteria to trigger the infection. Complications of heart disease, liver, or kidney problems are also causes of ascites.

Secondary peritonitis occurs with an infection caused by some other condition. This happens most often due to the spread of bacteria or infection inside the abdomen, which in turn allows the bacteria to enter the peritoneum. This can happen through a number of reasons:

  • Surgery in the abdomen
  • Infection of the blood
  • Fallopian tube inflammation
  • Crohn’s disease
  • Injury to the abdomen, such as a stab
  • Inflammation of the pancreas, which in turn leads to bacteria spreading outside the pancreas
  • Ruptured appendix

4 Making a Diagnosis

Your doctor will ask about your medical history and perform a physical exam to made a diagnosis. Peritonitis with peritoneal dialysis is easy to diagnose because of the cloudy dialysis fluid.

If it is secondary peritonitis or spontaneous peritonitis, your physician will recommend tests such as:

  • Blood tests: To check for a high white blood cell count and look for bacteria
  • Imaging tests: X-rays, CT scans, or ultrasounds may be used
  • Peritoneal fluid analysis: Your doctor obtains fluid through paracentesis, and if you have peritonitis, it will show an increase in your white blood cell count, which means there is inflammation, bacteria, or an infection. 

5 Treatment

Treatments for secondary peritonitis include:

  • Antibiotics: The use of antibiotics depends on what type of peritonitis you have and the severity of your condition. Initial treatment involves antibiotic injections or, if required, antifungal medicines. These usually last 10 to 15 days. If the main cause of peritonitis is from peritoneal dialysis, the doctor will inject the antibiotics directly into the peritoneum rather than the vein, which would be less effective. Painkiller medications are recommended if the person is suffering from extreme pain.
  • Surgery: This is done to remove the infected tissue, treat the infection, and prevent it from spreading, especially if it results from a ruptured colon, appendix, or stomach. Some patients develop swellings filled with pus in their peritoneum, which needs to be drained promptly to avoid any further complications. This is done by using a needle, inserted into the abscess with the guidance of an ultrasound scanner. In carrying out such procedures, the doctor will usually give a local anesthetic to the patient so they do not feel any pain.
  • Other treatments: These include intravenous (IV) fluids, supplemental oxygen, pain medications, and blood transfusions.
  • Nutritional guidance: Those suffering from peritonitis usually have problems digesting foods, so the doctor may suggest inserting a feeding tube, if deemed necessary. The tube would either be passed into the stomach via the nose or surgically placed into it. If neither of these options works, the doctor will pass the nutrients directly into a vein, a procedure known as parenteral nutrition.

Your doctor will recommend that you receive dialysis in another way for several days while your body heals from the infection.

6 Prevention

Follow some of these steps to prevent peritonitis if you are undergoing peritoneal dialysis:

  • Wash your hands before touching the catheter
  • Store your supplies in a sanitized area
  • Clean the skin around the catheter every day with antiseptic
  • Wear a surgical mask during your dialysis fluid exchanges
  • Talk to your dialysis care team about how to properly care for your catheter
  • Do not sleep with your pets

Germs around the catheter are sometimes the cause of peritonitis.

If you develop a new injury or abdominal pain, seek immediate medical attention, especially if the pain is so severe that you cannot sit still or find a comfortable position.

7 Alternative and Homeopathic Remedies

Homeopathic remedies for peritonitis include:

  • Aconite (Acon)
  • Bryonia
  • Belladonna (Bell)
  • Mercurials (Merc)
  • Rhus toxicodendron (Rhus-t)
  • Lachesis (Lach)

These medicines should be taken with professional advice.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to prevent peritonitis. Make sure you have good hygiene to prevent a bacterial infection, and be sure to wash your hands and ask for medical assistance when needed.

9 Risks and Complications

Some of the factors that increase your risk of peritonitis are:

  • Peritoneal dialysis
  • History of peritonitis
  • Other medical conditions, such as appendicitis, stomach ulcers, cirrhosis, Crohn’s disease, pancreatitis, and diverticulitis
  • Sepsis: This is an infection that can progress rapidly and lead to organ failure, shock, and even death. Sepsis usually happens when one or more organs of the body is damaged due to infection. Significant blood loss to various tissues and organs can cause sepsis. The patient usually develops symptoms very quickly that include sudden chills in the body, irregular and fast heartbeat, fast breathing, and a sudden rise in temperature. People suffering from sepsis should be given lots of fluids directly into the vein. Apart from this, doctors will also provide antibiotic injections to revive the patient before they go into septic shock.
  • Septic Shock: This is a type of sepsis where the patient’s blood pressure levels drop severely, leading to shock. Symptoms include fast heartbeat and cold skin. If not controlled, sepsis can interfere with and cause damage to the body’s vital functioning and even lead to death.
  • Post-Operation Complications: The highest number of complications usually occurs within one to three days after surgery. However, there are certain complications which can occur several days after the operation or even later.

Complications that can occur immediately after an operation include:

  • Loss of blood, shock, or septicemia
  • Lung collapse
  • Low output of urine

Complications that can occur post-operation include:

  • Pneumonia                                       
  • Pain
  • Nausea
  • Dizziness
  • Disturbance in sleep
  • Signs of confusion
  • Dehydration due to loss or reduced fluid intake
  • Wound infection
  • Obstruction in bowel movement
  • Persistent sinus infection that becomes severe over time
  • Formation of keloid
  • Hernia
  • Bowel obstruction

One of the main worries post-operation is infection. However, thanks to prophylactic antibiotics, there has been a decrease in the number of infections post-surgery, but multi-resistant organisms still pose a challenge. One of the most common forms of infection occurs from superficial wounds, which usually happen in the first week after surgery. There is a slight redness in the area followed by pain and discharge. Gas gangrene is also a possibility, but it is non-threatening and quite uncommon.

Wound healing complications: Most of the time, wounds heal without causing any complications and do not require further treatment. However, elderly people or those with impaired immunity face certain threats posed by wounds since they do not heal easily. Certain factors which cause hindrance in the healing of a wound are reduced or poor blood supply, vitamin deficiency, malnutrition, rheumatoid disease, radiotherapy, steroids, and extreme suture tension.

Injury during surgery: Sometimes, unavoidable damage to tissue or nerves occurs during surgery. There is also risk of injury under general anesthetic or while being shifted and handled in the operating theater.

Urinary problems: Another common post-operation complications is urinary retention. If there are any issues with urine, a catheterization could be required depending on the surgical factors. UTI is a common problem, especially in women. Antibiotic treatment along with adequate fluid intake can help take care of this. Acute kidney injury can also be a post-operation complication.

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