Peritonitis: Rapid Diagnosis, Etiologies, & Emergency Management.
Peritonitis
usually occurs when germs enter the
peritoneum. This can happen in several ways:
1. Ruptured organs:
A
burst appendix, a
perforated stomach ulcer, or a
hole in the colon
(due to conditions like
diverticulitis
or
inflammatory bowel disease) can release bacteria into the normally sterile
peritoneal cavity.
2. Infection spread:
Infections from other abdominal organs, such as the
pancreas
(pancreatitis) or
gallbladder
(cholecystitis), can spread to the peritoneum. In women,
pelvic inflammatory disease
can also lead to peritonitis.
3. Trauma:
Injury to the abdomen can introduce bacteria or chemicals into the
peritoneum.
4. Medical procedures:
Peritoneal dialysis: Infection can occur through the catheter used in this
kidney failure
treatment if hygiene practices are inadequate.
Surgery: Although rare, infection can occur after abdominal surgery.
Endoscopy
or
colonoscopy: Rarely, these procedures may lead to perforation and subsequent
peritonitis.
Feeding tubes: Tubes inserted through the abdomen for feeding may sometimes lead to
infection.
Fluid drainage: Procedures that remove fluid from the abdomen (e.g., for
ascites
due to
liver disease) carry a small risk of infection.
5. Spontaneous Bacterial Peritonitis (SBP):
This type of peritonitis can occur in individuals with liver disease,
particularly
cirrhosis, and fluid buildup in the abdomen (ascites). The fluid can become infected
without an apparent external source of bacteria. It can also occur in children
with
nephrotic syndrome
(a kidney disorder).
6. Other irritants:
Occasionally, peritonitis can result from the leakage of sterile but
irritating body fluids, such as
bile
(from a
perforated gallbladder),
pancreatic enzymes
(from pancreatitis), or
stomach acid
(from a
perforated ulcer).
Ruptured cysts
or
tumours
in the abdomen can also lead to
chemical peritonitis.
Seek immediate medical attention if you experience these signs and symptoms,
as peritonitis is a medical emergency.
Diagnosis of Peritonitis:
Doctors typically use the following methods to diagnose peritonitis:
1. Physical examination: Checking for abdominal tenderness, rigidity, and
other signs.
2. Medical history: Discussing symptoms and any underlying medical conditions
or procedures.
3. Blood tests: Looking for signs of infection, such as an elevated white
blood cell count. Blood cultures may be performed to identify bacteria in the
bloodstream.
4. Imaging tests:
X-rays: To check for perforations or other abnormalities in the
digestive tract.
Ultrasound
or
CT scan: To obtain detailed images of the abdominal organs and identify potential
causes of peritonitis, such as a
ruptured appendix
or
abscess.
5.
Peritoneal fluid analysis: If there is fluid in the abdomen (especially in patients on peritoneal
dialysis or those with ascites), a sample may be taken with a needle and
tested for infection. An increased white blood cell count and the presence of
bacteria in the fluid indicate peritonitis.
Treatment of Peritonitis:
Treatment for peritonitis requires hospitalization and prompt intervention:
1. Antibiotics: Administered intravenously (through a vein) to combat the
infection. The specific antibiotic depends on the suspected cause of the
infection.
2. Surgery: Often necessary to address the underlying cause of the
peritonitis, such as removing a ruptured appendix, repairing a perforated
ulcer, or
draining an abscess. The surgeon will also clean out the abdominal cavity (lavage) to remove infected material.
3. Supportive care:
-
Intravenous fluids: To prevent dehydration and maintain blood
pressure.
- Pain medication: To manage discomfort.
- Oxygen: If needed, to assist with breathing.
- Blood transfusion: In some cases.
-
Nutritional support: If the person cannot eat, a feeding tube or intravenous
nutrition may be required.
For
peritoneal dialysis-related peritonitis, treatment may involve antibiotics administered directly into the peritoneal
cavity or intravenously. In some cases, temporary
hemodialysis
(another form of dialysis) may be necessary until the infection resolves. If
peritonitis recurs, a switch to a different type of dialysis may be needed
long-term.
Prevention of Peritonitis.
Prevention strategies depend on the underlying risks, particularly for
patients undergoing peritoneal dialysis, who should strictly adhere to hygiene
protocols during their treatments.
Review the Peritonitis Management Protocol: Time-Sensitive Interventions.
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