What is peritonitis?
Peritonitis is an inflammation of the peritoneum, a membrane that lines the walls of the abdomen and the organs that are found there. It is caused by a bacterial or fungal infection, but it can be caused by a non-infectious process, such as perforation of the abdomen. Most of the time, it is a complication resulting from other problems, such as infection in Organs abdominal organs.
This condition requires immediate medical attention, as the infection may not go away on its own. Sometimes you may need emergency surgery. When necessary, the adjacent disease should be treated, that is, the one that gave rise to this complication.
Peritoneum is a two-layer membrane that covers and supports the abdominal organs, such as the stomach, intestines, pancreas, kidneys, etc. Between these two layers, there is a cavity filled with a liquid that allows frictionless movement.
Normally, there is no more than 50mL of fluid within this membrane, but women of reproductive age may experience a small increase in this number due to fluid retention during the premenstrual phases (PMS).
In general, it is not normal for the peritoneum to become infected easily. Therefore, when an infection occurs, it is a sign that the bacteria have already come from elsewhere and have reached that membrane.
The types of peritonitis can be classified according to their origin, location and duration.
Classification according to origin
It happens when the infection comes through the blood or directly from the abdominal cavity. In other words, it does not reach local bodies. It is a rarer type of peritonitis.
Normally, peritonitis is secondary, that is, the infection comes from one of Organs abdominal organs. It happens when there is an intestinal infection, for example, that spreads to the peritoneum.
There are rare cases in which peritonitis persists even after medical and surgical treatment. These cases receive a new classification, termed tertiary, and are generally caused by antibiotic- resistant bacteria .
Classification by location
When it reaches the entire peritoneum, peritonitis is called diffuse.
In localized peritonitis, the infection occurs in only part of the peritoneum.
Classification according to duration
When it lasts a few weeks, peritonitis is classified as acute.
Infections that last for more than 1 month are classified as chronic.
A last type of peritonitis is spontaneous, which occurs when there is an acute infection of the peritoneal fluid, that is, the fluid that eliminates friction between the two layers of the membrane.
It mainly affects patients with ascites , a condition characterized by the accumulation of fluids in the peritoneum.
The main cause of peritonitis is bacterial infection, but it can also be traced to other factors. Understand:
Bacterial infection of the peritoneum can occur in several ways. One of them is the secondary infection, in which another organ was already infected and the bacteria spread to the peritoneum.
Another way is when there is a systemic infection (of the whole body) and the bacteria reach the peritoneum through the blood.
Some bacteria commonly associated with infectious peritonitis are Escherichia coli , Klebsiella pneumoniae and Streptococcus pneumoniae .
Patients suffering from kidney failure may require hemodialysis, that is, the filtration of blood from outside the body. Sometimes, it is necessary that this dialysis be done through the peritoneum, and this can lead to infections at the site.
Perforation and abdominal trauma
When the abdomen or any organ in the area is punctured or injured (trauma), an inflammatory response of the peritoneum is activated. If left untreated, this perforation can lead to infection.
The human body is full of sterile fluids, such as blood, gastric juice, urine, among others. Because they are sterile, they generally do not carry bacteria with them. However, when these fluids leak to other parts of the body, such as the peritoneum, they can be easily infected.
It is worth remembering that there are several diseases that cause this leak, such as:
- Gastric ulcers;
- Inflammation of the gallbladder;
- Diverticulitis, Crohn’s disease and other intestinal inflammations;
- Renal or hepatic complications;
- Changes in blood vessels.
As inflammation is a natural reaction of the body to aggression, the entry of such fluids from the peritoneum activates this response in the body. Generally, fluid leakage peritonitis turns into infectious peritonitis within 24 to 48 hours.
The aggression that the abdominal tissues undergo during surgery causes an inflammatory response in the peritoneum.
Hereditary or autoimmune diseases
There are several genetic or autoimmune diseases that can lead to inflammation of the peritoneum. An example is systemic lupus erythematosus, in which the body attacks healthy cells in the body and causes an inflammatory response.
Anyone can develop peritonitis, but there are some factors that help the development of the condition. Are they:
- Liver problems : liver problems, such as cirrhosis, lead to leakage of fluids into the peritoneum;
- Alcoholism: alcohol addiction leads to liver disease;
- Ascites: the accumulation of fluids in the peritoneum facilitates the proliferation of bacteria, which causes an infection;
- Weakened immune system: as the immune system is our defense against microorganisms, when it is weak, the body cannot resist and the infection takes over;
- Pelvic inflammatory disease: when there is infection in the woman’s reproductive organs, it can spread to the peritoneum;
- Other medical conditions in the digestive tract: Problems such as diverticulitis, Crohn’s disease, gastric ulcers and pancreatitis can cause complications that progress to peritonitis.
Peritonitis has several symptoms that are common in several other diseases, such as:
- Abdominal pain that worsens when performing movements, such as walking, coughing or breathing;
- Abdominal distension (swollen abdomen), due to the accumulation of liquids, feces or gases;
- Diffuse abdominal stiffness;
- Sinus tachycardia (type of cardiac arrhythmia with a frequency greater than 100 beats per minute);
- Paralytic ileum (inability of the intestine to move and expel feces);
- Urinating less frequently than normal;
- Difficult digestion of food;
- Nausea and vomiting;
- Intense venue;
The diagnosis of peritonitis can be made by a general practitioner, nephrologist, hepatologist, gastroenterologist, emergency physician, intensive care physician or even an infectious disease. The tests done to diagnose the problem are:
At first, the doctor will look for physical signs of the disease. For this, the doctor will perform procedures such as palpation and auscultation of the abdomen. One possible result is the Blumberg sign, characterized by intense pain when the doctor touches the patient’s abdomen.
Tests are done to show the markers of an infection, such as the presence of antigens.
X-rays and CT scans
These imaging tests help the doctor to visualize the organs inside the body, helping him to see what the problem is.
In this procedure, the doctor takes a sample of the liquid in the peritoneum through a fine needle. The sample is sent for laboratory analysis, which will indicate whether there is an infection or not.
Peritonitis itself is curable , as the infection can be eradicated. However, in the case of people who have liver disease, the disease may return due to the accumulation of fluids in the abdomen.
Often, the patient is hospitalized because it is a medical emergency. In many cases, emergency surgery is performed to treat the cause of the peritonitis.
Due to the loss of fluids, as a result of vomiting, it is necessary to replace hydration. This process can be done intravenously (through the veins), since vomiting makes it impossible for fluids to pass through the digestive system.
A probe is used to drain the fluid in the peritoneum region. This also helps in the treatment of the infection, because the bacteria reproduce less without the presence of the liquid.
Oxygen and blood transfusion
In some cases the patient loses a lot of blood and may need a transfusion. Oxygen can be administered if the person has difficulty breathing.
When surgery is necessary, it is necessary to clean the peritoneum with saline.
Because of the infection, the doctor may prescribe antibiotics, usually intravenously, to eliminate the bacteria.
Doctors commonly prescribe antibiotics for the treatment of peritonitis. This type of medicine helps to eliminate the bacteria and end the infection.
Some examples are:
- Norfloxacin .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
When treated, peritonitis can be cured, but if it is not done, the disease is almost always fatal. The mortality rate is 10% in young patients and 40% in the elderly and people with underlying diseases.
Peritonitis presents complications such as:
If the disease is not treated, the evolution of the infection generates a proliferation of bacteria for the whole organism, leading to a generalized infection.
The abscess forms when the organism isolates the bacteria in a kind of capsule, thus preventing the bacteria from spreading. The problem is that this capsule can burst and end up releasing bacteria in the body again.
The liquid accumulated in the abdomen compresses the diaphragm, the muscle responsible for breathing, causing breathing difficulties.
Due to the accumulation of fluids outside of their original organs, electrolyte disturbances can occur that lead to hypovolemia, a condition in which there is a lack of fluids in the bloodstream and can lead to death due to overload in the heart.
If left untreated, peritonitis leads to death.
There are no specific ways to prevent peritonitis. However, you can prevent risk factors with the following tips:
- Avoid excessive consumption of alcohol to avoid damage to the liver;
- Have a balanced diet;
- Exercise regularly to help you stay healthy.
For those who need to undergo hemodialysis via the peritoneum, some tips are:
- Wash your hands thoroughly before touching the catheter;
- Keep the catheter application area sanitized, cleaning it daily with antiseptic;
- Store your dialysis-related supplies and equipment in an area that is properly sanitized and sterilized;
- If in doubt, talk to the team that assists the process regarding the proper use and cleaning of the catheter.
Peritonitis can be severe but has an effective treatment. Share this information with your friends and don’t forget to see your doctor regularly.