Peritonitis
Condition
Definition
Peritonitis is inflammation of the peritoneum. This is the thin tissue that covers the inside of the abdomen. It also covers the outside of the intestines and other abdominal organs.
There are three types:
- Primary (Spontaneous Bacterial Peritonitis)
- Secondary
- Dialysis-related
This health problem needs care right away. It can be deadly.
Causes
Peritonitis is caused by infection. Common causes are:
- Primary—fluid buildup in the abdomen (ascites) becomes infected. Ascites is caused by health problems, such as cirrhosis of the liver .
- Secondary—bacteria enters the belly due to an injury or health problem, such as a ruptured appendix.
- Dialysis-related—bacteria enters the peritoneal cavity during or after peritoneal dialysis to treat kidney disease.
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Risk Factors
Things that may raise the risk of peritonitis are:
- Trauma or recent surgery
- Problems with the way the body fights infection
- Blood or fluid (ascites) in the abdomen
- A ruptured appendix
- Digestive problems such as:
- Peptic ulcer
- Colitis
- Diverticulitis
- Gangrene of the bowel
- Pancreatitis
- Inflamed gallbladder
- Pelvic inflammatory disease
- Tubes or shunts in the abdomen
- Cortisone medicines
Symptoms
Problems may be:
- Belly pain that is worse when moving
- Bloating
- Digestive symptoms, such as:
- Constipation
- Nausea and vomiting
- Fever
- Lack of energy
- Lightheadedness
- Shortness of breath or fast heartbeat
- Passing less urine (pee)
Diagnosis
The doctor will ask about symptoms and past health. A physical exam will be done.
Blood tests will be done.
Fluid may be taken from the peritoneum for testing. This can be done with paracentesis .
Images may be taken of the abdomen. This can be done with x-rays and CT scans.
Surgery may be done to look inside the abdomen. This can be done with laparotomy .
Treatment
The underlying cause will need to be treated. This may involve things like surgery to remove a ruptured appendix.
The goal of treatment is to ease the inflammation. Antibiotics or antifungal medicine will be given by mouth or IV to treat infection.
Prevention
Antibiotics may be given to prevent spontaneous bacterial peritonitis if a person has:
- Cirrhosis with:
- Bleeding in the digestive tract
- Low protein in the ascitic fluid
- Reduced kidney function
- Severe liver disease
- A past episode of spontaneous bacterial peritonitis
American College of Gastroenterology
American Gastroenterological Association
CANADIAN RESOURCES:
Canadian Digestive Health Foundation
Health Canada
American College of Gastroenterology
American Gastroenterological Association
CANADIAN RESOURCES:
Canadian Digestive Health Foundation
Health Canada
References
- Marciano S, Díaz JM, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. Hepat Med. 2019;11:13-22.
- Secondary bacterial peritonitis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/secondary-bacterial-peritonitis.
- Spontaneous bacterial peritonitis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/spontaneous-bacterial-peritonitis.
- Spontaneous bacterial peritonitis (SBP). Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/spontaneous-bacterial-peritonitis-sbp.
Contributors
- Daniel A. Ostrovsky, MD
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