Elliot Kim
Peritonitis is a life-threatening condition that requires prompt medical attention. It is an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. The abdomen is often distended, with hypoactive-to-absent bowel sounds. This finding reflects a generalized ileus, which is a failure of peristalsis and the normal physiologic response of the intestine to peritoneal inflammation. Bowel sounds will be markedly diminished or absent in ileus as the intestine distends with gas in its paralyzed state. The diagnosis of peritonitis is usually clinical and based on examination, blood tests, and medical imaging.
| Characteristics | Values |
|---|---|
| Definition | Inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein |
| Cause | Bacterial infection, abdominal trauma, ingestion of a sharp foreign body, perforation by an endoscope or catheter, anastomotic leakage, pancreatitis, pelvic inflammatory disease, stomach ulcer, cirrhosis, a ruptured appendix, perforated gallbladder, perforated bowel |
| Symptoms | Abdominal pain, abdominal tenderness, abdominal guarding, rigidity, swelling of the abdomen, fever, weight loss, nausea, vomiting, bloating, abdominal distension, hypoactive-to-absent bowel sounds, pain during rectal examination, signs of shock (low blood pressure, abnormal pulse rate, pale skin) |
| Diagnosis | Clinical, physical examination, blood tests, medical imaging (X-rays, CT scans), laparoscopy, peritoneal fluid culture |
| Treatment | Hospitalization, antibiotics, intravenous fluids, surgery, pain medication, nasogastric tube, blood transfusion |
| Complications | Sepsis, shock, acute kidney failure, acute respiratory distress syndrome, death |
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What You'll Learn
- Peritonitis is inflammation of the abdominal membranes, caused by bacterial infection
- Symptoms include abdominal pain, swelling, fever, weight loss, and tenderness
- Diagnosis involves physical examination, blood tests, X-rays, and laparoscopy
- Treatment options include hospitalisation, antibiotics, and surgery
- Complications can lead to shock, acute kidney failure, and respiratory distress
Peritonitis is inflammation of the abdominal membranes, caused by bacterial infection
Peritonitis is a severe inflammation of the peritoneum, the thin membrane that lines the abdominal cavity and covers the abdominal organs. It is a serious medical condition that can lead to life-threatening complications if not treated promptly. Bacterial infections are the most common cause of peritonitis. The inflammation is often triggered by a bacterial infection in a nearby organ that spreads to the peritoneum. This can happen through a perforated bowel, allowing bacteria-laden digestive juices and food to leak into the abdominal cavity. Conditions such as diverticulitis and inflammatory diseases like Crohn's disease can damage the intestines and lead to perforation.
Additionally, a burst appendix can result in peritonitis. The appendix can become infected with bacteria when food or faecal matter becomes lodged inside it. Peritonitis can also occur due to a perforated gallbladder caused by a severe infection called cholecystitis. Another cause is pancreatitis, where an inflamed pancreas directly causes inflammation in the abdomen. Abdominal trauma, such as ingestion of sharp foreign objects or injuries sustained during surgery, can also lead to peritonitis by allowing microorganisms to enter the peritoneal cavity.
Spontaneous bacterial peritonitis (SBP) is a form of peritonitis that occurs without an obvious source of contamination. It is commonly associated with ascites, an abnormal build-up of fluid in the abdomen, which can be caused by conditions such as cancer, cirrhosis, or congestive heart failure. SBP is a significant concern in patients with ascites, especially those with acute clinical deterioration. Peritonitis can also develop from peritoneal dialysis or tube feeding, as these procedures can introduce bacteria into the peritoneal cavity.
The diagnosis of peritonitis is typically clinical and involves a physical examination, blood tests, and medical imaging. During the physical examination, the abdomen is usually found to be hard and painful, with absent bowel sounds. Patients with severe peritonitis often exhibit increased abdominal wall rigidity and may keep their hips flexed to relieve abdominal tension. In some cases, an inflammatory mass may be palpable. Laboratory tests, including blood tests and peritoneal fluid culture, help identify the specific bacteria responsible for the infection to guide antibiotic treatment. Medical imaging, such as X-rays and laparoscopy, aids in visualizing the abdomen and abdominal organs to assess the extent of inflammation and identify any structural abnormalities.
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Symptoms include abdominal pain, swelling, fever, weight loss, and tenderness
Peritonitis is an inflammation of the peritoneum, the tissue that lines the inside of the belly. It is often a medical emergency that can cause life-threatening complications. The symptoms of peritonitis include abdominal pain, swelling, fever, weight loss, and tenderness.
Abdominal pain is a common symptom of peritonitis and is often described as sudden and severe. This pain is exacerbated by moving the peritoneum, such as through coughing, flexing the hips, or eliciting the Blumberg's sign. Pressing on the abdomen and then releasing the hand abruptly will also cause more pain as the peritoneum snaps back into place. The pain typically starts as generalized abdominal pain and may become localized later.
Abdominal swelling, or distension, can also occur in peritonitis due to the accumulation of fluid and inflammation in the abdomen. This swelling can be a sign of the body's inflammatory response to infection or injury. It is often associated with other symptoms such as abdominal pain, tenderness, and rigidity.
Fever is another possible symptom of peritonitis. It is a common sign of the body's immune response to infection or inflammation. In the case of peritonitis, the fever may indicate the presence of an infection or the body's attempt to fight off invading microorganisms.
Weight loss can also be a symptom of peritonitis, although it is not as commonly mentioned as the other symptoms. Weight loss can be a sign of chronic inflammation or infection, indicating a prolonged or severe case of peritonitis. It can also be a result of decreased appetite or digestive issues associated with the condition.
Abdominal tenderness and rigidity are also characteristic symptoms of peritonitis. Tenderness refers to pain or discomfort when the abdomen is touched, while rigidity involves the involuntary contraction of the abdominal muscles, making them feel hard to the touch. Both symptoms are highly specific for diagnosing peritonitis and are often present together, indicating peritonism.
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Diagnosis involves physical examination, blood tests, X-rays, and laparoscopy
Peritonitis is the inflammation of a thin layer of tissue inside the abdomen, often caused by infection. It is a medical emergency. Diagnosis of peritonitis involves physical examination, blood tests, X-rays, and laparoscopy.
During a physical examination, patients with peritonitis generally appear unwell and in acute distress. Their temperature often exceeds 38° C, although patients with severe sepsis may become hypothermic. Tachycardia may be present, and with progressive dehydration, patients may become hypotensive. On abdominal examination, patients with peritonitis demonstrate tenderness to palpation and increased abdominal wall rigidity. The abdomen is often distended, with hypoactive-to-absent bowel sounds.
Blood tests, such as a complete blood count (CBC), can measure white blood cell (WBC) and red blood cell (RBC) counts. A high WBC count usually indicates inflammation or infection, while a low RBC count may suggest intra-abdominal bleeding. A blood culture can help identify the bacteria causing the infection.
X-rays, as well as other imaging techniques like CT scans, can reveal any perforations or holes in the peritoneum. They can also detect peritoneal thickening and fluid accumulation, which are key features of peritonitis.
Laparoscopy, a minimally invasive surgical technique, is used for diagnosis and treatment. It involves inserting a thin, lighted tube with a camera through a small incision in the abdomen. Laparoscopy helps identify the cause of peritonitis, confirm the pathology, and guide appropriate treatment procedures.
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Treatment options include hospitalisation, antibiotics, and surgery
Peritonitis is a serious condition characterised by severe inflammation of the thin membrane (peritoneum) that lines the inside of the belly. It is often caused by a bacterial infection in the peritoneum and can lead to life-threatening complications such as sepsis. Treatment options for peritonitis include hospitalisation, antibiotics, and surgery.
Hospitalisation is often necessary for individuals with peritonitis to receive appropriate medical care and monitoring. During hospitalisation, healthcare providers focus on stabilising the patient and preventing the development of sepsis or septicemia, which are severe complications of peritonitis. Intravenous (IV) fluids are typically administered to maintain fluid balance, reduce the risk of shock, and support the patient's overall health.
Antibiotics play a crucial role in the treatment of peritonitis, especially when the condition is caused by a bacterial infection. Broad-spectrum antibiotics are initially used as the first line of defence to combat the infection. Once the specific bacterium or pathogen causing the infection is identified through blood tests and culture results, healthcare providers may transition to a different antibiotic specifically targeted at the identified organism. Antibiotic therapy aims to prevent the spread of the infection and reduce late complications.
The choice of antibiotics depends on the type of peritonitis, with different regimens available for spontaneous bacterial peritonitis (SBP), secondary peritonitis, and tertiary peritonitis. For example, oral ofloxacin has been found to be effective in treating SBP, while intravenous ciprofloxacin followed by oral ciprofloxacin has also been used successfully. In secondary peritonitis, systemic antibiotic therapy is typically administered after source control measures such as the removal of the appendix or drainage of an abscess. Antibiotic therapy is most effective when initiated early and can significantly reduce the concentration and growth of bacteria in the peritoneal fluid.
In some cases, surgery may be required as a treatment option for peritonitis. Source control procedures, such as the closure of perforations, resection of gangrenous bowel, or drainage of abscesses, can help manage the condition and prevent further complications. Surgery is often considered when other treatment methods have not been successful or when there is a need for direct intervention to address the underlying cause of peritonitis.
The recovery time for peritonitis varies, and early treatment improves the chances of a faster recovery. Underlying conditions that contributed to the development of peritonitis should also be addressed to prevent recurrence and ensure a full recovery.
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Complications can lead to shock, acute kidney failure, and respiratory distress
Peritonitis is a serious condition that can lead to life-threatening complications. It is usually caused by a bacterial or fungal infection in the belly area, often due to a rupture such as a burst appendix, or from trauma to the abdomen. It can also occur as a complication of peritoneal dialysis or other medical problems. Those undergoing peritoneal dialysis are at particular risk of infection, although improved technology and self-care methods have helped to lower this risk.
One of the most severe complications of peritonitis is acute respiratory failure, which can be caused by the emergence of gram-negative pneumonia by the third day of the onset of peritonitis. This complication carries a high fatality rate, with 89% of deaths attributed to uncontrolled sepsis rather than respiratory failure itself. Non-invasive ventilation and the early use of positive expiratory pressure with mechanical ventilation can help manage respiratory failure and improve hypoxia.
Peritonitis can also lead to shock and acute kidney failure. Treatment for bacterial infections usually involves intravenous antibiotics, alongside supportive treatments such as IV fluids and drugs to maintain blood pressure, especially if sepsis is a concern. In some cases, emergency surgery may be required to address a ruptured appendix or other related conditions, or to remove damaged parts of the peritoneum.
The seriousness of peritonitis means that anyone experiencing symptoms should seek immediate medical attention. A physical exam will be conducted, and common diagnostic procedures include blood tests, X-rays, and computerized tomography (CT) scans. Treatment options will depend on the specific cause and severity of the condition.
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Frequently asked questions
Peritonitis is the inflammation of the abdominal membranes, most commonly due to bacterial infection. It is a life-threatening condition that requires prompt medical treatment.
Symptoms of peritonitis include severe abdominal pain, abdominal tenderness, abdominal rigidity, swelling of the abdomen, fever, weight loss, and absent bowel sounds.
The diagnosis of peritonitis involves a clinical evaluation, including a physical examination, blood tests, and medical imaging such as X-rays or laparoscopy. During the physical examination, the abdomen is typically hard and painful, with reduced or absent bowel sounds.
