Symptoms of infectious peritonitis

Peritonitis is a bacterial or fungal infection of the peritoneum, a silky, serous skin that covers the inner abdominal wall and organs in the abdomen.

Infectious peritonitis can be caused by a tear (perforation) in the abdomen or a complication of other diseases.

Peritonitis requires immediate medical attention to fight the infection and, if necessary, treat the underlying medical conditions.
Septic peritonitis is characterized by a local or diffuse infection of the abdominal cavity. It can occur primarily or be caused by bacteria.

Acute peritonitis is a sudden infection of the peritoneum, for example, as a result of perforation of an organ.

Chronic peritonitis is a long-lasting inflammation of the peritoneum.

Possible causes are:

  • Repeated infections such as pelvic inflammatory disease (PID)
  • Foreign substances such as talc
  • Chronic diseases inside the abdominal cavity, such as tuberculosis, cirrhosis or chronic alcoholism



There are two main types of peritonitis.

Primary peritonitis, or spontaneous bacterial peritonitis, occurs when the infection spreads through the blood and through the lymph nodes to the peritoneum. This type of peritonitis is rare – less than 1% of peritonitis cases.
As a rule, it occurs when the patient suffers from cirrhosis of the liver and with existing ascites (water in the abdominal cavity).
If this fluid becomes infected with some bacteria (for example, pneumococci or streptococci), it can cause spontaneous bacterial peritonitis, which is an extremely serious and often fatal disease.

Secondary peritonitis is the most common type and occurs when the infection enters the peritoneum through a perforation in the abdominal wall.
Secondary peritonitis often turns into chemical peritonitis because, in addition to bacteria, other harmful substances can enter the peritoneum: gastric and pancreatic juice, mucus, bile and urine.
Both cases of peritonitis are very serious and can be life-threatening if not treated quickly.

Causes of acute peritonitis

The infection can develop directly in the peritoneum or spread from another part of the body.

Infections of other parts
of the body 
Often, peritonitis is caused by an infection that spreads from another part of the body.
This is called secondary peritonitis.
The most common causes of secondary peritonitis are:

  • Ulcers in the stomach
  • Acute appendicitis (appendicitis)
  • Acute pancreatitis (inflammation of the pancreas)
  • Severe abdominal traumas such as knife injuries or gunshot wounds
  • Digestive disorders such as diverticulitis or Crohn’s disease

Biliary peritonitis occurs when fluid leaks from the gallbladder or bile ducts. It is a serious complication and can be caused by inflammation or a gallbladder stone.
Both Crohn’s disease and diverticulitis can inflame the intestine.
If the inflammation is particularly severe, the intestine can break through and its contents can enter the peritoneum and contaminate it with bacteria.

Direct infection
Rarely, peritonitis occurs when the peritoneum is directly infected.
This is called primary or spontaneous peritonitis.
In most cases, primary peritonitis is caused by cirrhosis of the liver or peritoneal dialysis.

Liver fibrosis, also called cirrhosis, can occur due to liver damage. The most common causes of cirrhosis are alcohol abuse, infectious hepatitis C or obesity.
Cirrhosis of the liver can lead to fluid retention in the abdomen (so-called ascites). This fluid is particularly susceptible to infection, creating an environment where bacteria or fungi can grow and spread.
This fluid retention affects about half of people with cirrhosis, usually many years after it was diagnosed.
About 20% of people with cirrhosis who develop ascites also develop spontaneous bacterial peritonitis.

Peritoneal dialysis
People with renal insufficiency who undergo peritoneal dialysis as part of treatment are at risk of developing peritonitis. Dialysis is a medical treatment that performs the main functions of the kidney and removes the excretion products from the body.
Peritoneal dialysis is performed by using the peritoneum for kidney function, i.e. the excretion products are filtered out of the blood in this way. A small tube, called a catheter, is implanted into the blood vessels of the peritoneum to remove the excretory products.

Risk factors for peritonitis

The following factors can increase the risk of primary peritonitis:

  • Liver disease (cirrhosis)
  • Fluid in the abdomen
  • Weakened immune system
  • Pelvic inflammatory disease

Risk factors for secondary peritonitis:

  • Pancreatitis
  • Appendicitis (appendicitis)
  • Stomach ulcer
  • Bowel twist or tear
  • Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
  • Injury during surgery
  • Peritoneal
  • Trauma

Symptoms of acute peritonitis

The first symptoms of peritonitis are loss of appetite, nausea and dull abdominal pain, which very quickly turns into persistent and very severe abdominal pain, worsening with every movement.
Other signs and symptoms associated with peritonitis include:

  • Numbness or tightness in the abdomen
  • Ague
  • Fever
  • Fluid in the abdomen
  • Extreme thirst
  • Infrequent or decreased urination
  • Indigestion
  • Vomit

Complications of peritonitis

If left untreated, peritonitis can spread beyond the peritoneum and cause:

  1. Blood infection (bacteremia).
  2. Infection throughout the body (sepsis). Sepsis is a rapidly progressive disease that is dangerous and can lead to hypovolemic shock and failure of various organs.
  3. Intraperitoneal abscesses.
  4. Abdominal and intestinal adhesions (adhesions).

Diagnosis of peritonitis

Anyone who develops the symptoms of peritonitis should immediately notify the doctor.
Peritoneal dialysis patients who have a combination of abdominal pain and cloudy peritoneal fluid should see the doctor immediately, because the cause may be an accumulation of white blood cells that fight the infection.
Since peritonitis can quickly cause potentially fatal complications such as sepsis and septic shock, leading to massive drop in blood pressure, organ failure and death, rapid diagnosis followed by appropriate treatment is essential.

The doctor asks about the symptoms and medical history, and then performs a detailed physical exam to evaluate pain and abdominal hardness.

Examinations for peritonitis are:

  • Blood.
  • Apparative imaging examinations such as X-rays and CT.
  • Exploratory surgery.
  • The doctor may also perform paracentesis, a procedure in which fluid is taken from the abdominal cavity through a fine cannula and examined for infection. Paracentesis is used to identify primary spontaneous and secondary peritonitis caused by pancreatitis.

Therapy of pancreatitis

As soon as one receives the diagnosis of peritonitis, the doctor will probably arrange for further control to be admitted to the hospital.

In many cases, emergency surgery is required, especially if the peritonitis was provoked by the following diseases:

  • Appendicitis (appendicitis)
  • perforated stomach ulcer
  • Perforation of the gallbladder
  • Perforation of the colon by ulcerative colititis, Crohn’s disease or toxic megacolon
  • Diverticulitis

The infected tissue, for example, in appendicitis or abscess, must be surgically removed.
The peritoneal tissue, which has been severely damaged by the infection, must also be removed.
With peritonitis, which arises as a result of inflammation of the pancreas (pancreatitis) or pelvic inflammatory disease, surgery is not performed at the initial stage, because the patient could heal without a scalpel.

Further treatment measures are necessary if the patient develops organ insufficiency due to sepsis, which would be possible as a complication of peritonitis.
These include intravenous fluid injections, medications to stabilize blood pressure and artificial feeding (stomach tube).

The initial treatment of peritonitis involves the injection of antibiotics (cefotaxime, ceftriaxone, etc.) or antifungal drugs. This therapy usually lasts 10-14 days.
If the peritonitis was caused by peritoneal dialysis, the antibiotics can be injected directly into the peritoneum. Research has shown that this pathway is more effective than through the vein.
In addition, another method of dialysis, such as hemodialysis (the blood runs through the filter system of a machine) is required as long as the peritonitis persists.
If peritonitis causes pain, the doctor may administer painkillers.

Nutritional aids
Many people with peritonitis have problems with digestion and food utilization, so a feeding tube may be required.
The probe enters the stomach via the nose (nasogastral probe) or is surgically placed through the abdominal wall into the stomach.
If this is not possible, nutrition can be done directly through one of the veins (parenteral nutrition).

If part of the peritoneal tissue has been severely damaged by the infection, its surgical removal may be required.
Some people develop abscesses (pus-filled areas) in the peritoneum, which must be emptied with a cannula.
This is done by inserting a needle under ultrasound control.
As a rule, local anesthesia is performed so as not to feel pain.
If necessary, the cause of peritonitis is treated surgically.
The procedure is usually performed by means of a laparotomy with a vertical incision below the navel.
For example, if appendicitis has caused peritonitis, the appendix of the appendix (appendix) must be removed.

Prognosis of peritonitis

The prognosis of peritonitis depends on the cause. The outlook for people with secondary peritonitis is worse, especially for the elderly, people with weakened immune systems, and people who had symptoms for more than 48 hours before starting therapy.
Life expectancy for individuals with primary peritonitis due to liver disease is usually short.
However, the prognosis of primary peritonitis in children is usually very good after treatment with antibiotics.

Prevention of peritonitis

Although peritonitis can be the result of peritoneal dialysis, it occurs much less frequently when using the latest technologies and self-treatment techniques taught at initial admission.
When performing peritoneal dialysis, one can reduce the risks of peritonitis by following these recommendations:

  • Wash hands thoroughly before touching the catheter, including the areas between the fingers and under the nails.
  • wear a nose and mouth mask during dialysis,
  • Follow the correct technique of sterile dialysis,
  • Apply an antibiotic ointment every day in the place where the catheter exits,
  • Immediately report any contamination of the dialysis fluid or catheter to the nurse performing the dialysis. In many cases, the one-time dose of an antibiotic can prevent contamination from passing into infection.

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