Peritonitis (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Peritonitis is an inflammation (irritation) of the peritoneum, the tissue that lines the wall of the abdomen and covers the abdominal organs.

There are three specific types of peritonitis:
 * Spontaneous peritonitis: Spontaneous peritonitis is usually caused by ascites, a collection of fluid in the peritoneal cavity. This usually occurs from liver or kidney failure.
 * Secondary peritonitis:Secondary peritonitis is an inflammation of the peritoneum, the tissue lining the abdominal cavity. Secondary means it is due to another condition, most commonly the spread of an infection from the digestive tract.
 * Dialysis associated peritonitis: Dialysis-associated peritonitis is inflammation of the lining of the abdominal cavity (peritoneum), which occurs in those who receive peritoneal dialysis.

What are the symptoms of Peritonitis?

 * Abdominal distention
 * Abdominal pain or tenderness
 * Fever
 * Fluid in the abdomen
 * Inability to pass feces or gas
 * Low urine output
 * Nausea and vomiting
 * Point tenderness
 * Thirst

Additional symptoms that may be associated with this disease include:
 * Cloudy dialysis fluid (if undergoing peritoneal dialysis)
 * Nausea and vomiting
 * Shaking chills
 * Signs of shock

What are the causes of Peritonitis?
A collection of pus in the abdomen, called an intra-abdominal abscess, may cause peritonitis.

Who is at risk for Peritonitis?
Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis (Hepatitis B or C). Spontaneous peritonitis also occurs in patients who are on dialysis for kidney failure.

How to know you have Peritonitis (Diagnosis)?
The doctor will perform a physical exam. The abdomen is usually tender, and may feel firm and "board-like." The patient may extensively "guard" the area, using protective movements such as curling up or refusing to allow the area to be touched.

Blood tests, x-rays, and CT scans may be ordered.

When to seek urgent medical care
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of peritonitis.

Treatment options
The cause must be identified and treated promptly. Treatment typically involves surgery and antibiotics.

Spontaneous Peritonitis
Treatment depends on the cause of the peritonitis.
 * Surgery may be needed if peritonitis is caused by a foreign object, such as a catheter used in peritoneal dialysis.
 * Antibiotics may control infection in cases of spontaneous peritonitis with liver or kidney disease.
 * Intravenous therapy can treat dehydration.

Secondary Peritonitis
Surgery is usually necessary to remove sources of infection such as an infected bowel, inflamed appendix, or abscess.

General treatment includes:
 * Antibiotics
 * Fluids through a vein (IV)
 * Pain medicines
 * Tube through the nose into the stomach or intestine (nasogastric or NG tube)

Dialysis associated Peritonitis
The goal of treatment is to cure the infection. Antibiotics are given into a vein (intravenous injection) or into the lining of the abdomen (peritoneum).

Laboratory tests that show which bacteria or fungi are causing the infection will determine the type of antibiotic used.

Where to find medical care for Peritonitis
Directions to Hospitals Treating Peritonitis

Prevention of Peritonitis
Prevention depends on the cause and the specific type of peritonitis.


 * Spontaneous Peritonitis: Patients with peritoneal catheters should be treated with sterile techniques. In cases of liver failure, antibiotics may help prevent peritonitis from coming back.
 * Dialysis associated Peritonitis: Careful sterile technique when performing peritoneal dialysis may help reduce the risk of inadvertently introducing bacteria during the procedure. Some cases are not preventable. Equipment design improvements have made these infections less common.

What to expect (Outlook/Prognosis)
With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment. If properly treated, typical cases of surgically correctable peritonitis (e.g. perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48h). If untreated, generalised peritonitis is almost always fatal.