Peritonitis

• Peritonitis is the inflammation of the peritoneum, a membrane lining the abdomen, usually due to infection.
• It is often a medical emergency, requiring prompt diagnosis and treatment.
• Common causes include ruptured appendix, perforated ulcers, diverticulitis, or complications from medical procedures.
• Symptoms typically involve severe abdominal pain, tenderness, fever, and bloating.
• Treatment usually involves antibiotics and often surgery to address the underlying cause.

What is Peritonitis?

Peritonitis refers to the inflammation of the peritoneum, the serous membrane that forms the lining of the abdominal cavity and covers the abdominal organs. This condition can be life-threatening and requires immediate medical attention. It generally arises from an infection, which can spread from a ruptured organ within the abdomen or be introduced during medical procedures.

There are two main types: primary (spontaneous bacterial peritonitis), which occurs without an obvious source of infection, often in individuals with liver disease and ascites; and secondary peritonitis, which is far more common and results from a breach in the gastrointestinal or genitourinary tract, allowing bacteria to enter the peritoneal cavity.

Causes and Symptoms of Peritonitis

Understanding the peritonitis causes and symptoms is crucial for early detection and intervention. Secondary peritonitis, the most common form, typically results from a perforation or rupture of an abdominal organ, allowing digestive fluids, bile, or bacteria to leak into the sterile peritoneal cavity. Primary peritonitis, though less common, often affects individuals with underlying conditions such as cirrhosis and ascites, where fluid accumulation in the abdomen creates a fertile ground for bacterial growth.

Common causes of secondary peritonitis include:

• Ruptured appendix
• Perforated stomach ulcer
• Diverticulitis with perforation
• Pancreatitis
• Trauma to the abdomen
• Complications from abdominal surgery
• Peritoneal dialysis (dialysis-associated peritonitis)

The symptoms of peritonitis often develop rapidly and can be severe. Patients typically experience intense, sudden abdominal pain that worsens with movement or touch. Other common symptoms include:

• Abdominal tenderness and rigidity (a board-like abdomen)
• Bloating or distension of the abdomen
• Fever and chills
• Nausea and vomiting
• Loss of appetite
• Decreased urine output
• Rapid heart rate (tachycardia)

These symptoms warrant immediate medical evaluation, as untreated peritonitis can lead to severe complications, including sepsis and organ failure.

Diagnosing and Treating Peritonitis

Diagnosing peritonitis involves a combination of physical examination, laboratory tests, and imaging studies. During a physical exam, a doctor will typically find a tender and rigid abdomen, often with rebound tenderness (pain upon release of pressure). Blood tests usually show an elevated white blood cell count, indicating infection, and increased inflammatory markers. Imaging techniques such as CT scans, ultrasounds, or X-rays of the abdomen are often used to identify the source of the infection, such as a ruptured appendix or a perforated organ. In some cases, a paracentesis (sampling of peritoneal fluid) may be performed to analyze the fluid for bacteria or other signs of infection.

Effective peritonitis treatment options are critical and generally involve a multi-pronged approach, focusing on controlling the infection and addressing the underlying cause. Treatment typically includes:

• Antibiotics: Broad-spectrum antibiotics are usually administered intravenously immediately to combat the bacterial infection. Once the specific bacteria are identified, the antibiotic regimen may be adjusted.
• Surgery: Surgical intervention is often necessary, especially in cases of secondary peritonitis. The goal of surgery is to repair the underlying cause, such as closing a perforation, removing infected tissue (e.g., a ruptured appendix), or draining abscesses.
• Supportive Care: Patients usually receive intravenous fluids to prevent dehydration and maintain blood pressure, pain medication to manage discomfort, and sometimes nutritional support.

Early diagnosis and prompt treatment significantly improve outcomes. According to the Centers for Disease Control and Prevention (CDC), timely medical intervention is crucial for severe infections like peritonitis to prevent life-threatening complications such as sepsis and septic shock. Without rapid treatment, peritonitis can lead to widespread infection, organ failure, and death.