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What Is Peritonitis Symptoms Causes Diagnosis Treatment and Prevention
By Cathy CassataMedically Reviewed by Sanjai Sinha, MDReviewed: November 23, 2020Medically ReviewedPeritonitis is a bacterial or fungal infection of the peritoneum, the thin, silklike membrane that lines your inner abdominal wall. The peritoneum protects the organs within your abdomen, such as your liver, stomach, and intestines.Peritonitis results in pain, inflammation, and irritation, and requires immediate medical attention to treat the infection and any underlying condition that may have caused it. Most Recent in Peritonitis
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See all in Peritonitis Signs and Symptoms of Peritonitis
Numerous symptoms are linked to peritonitis, including:Abdominal pain or tendernessBloating or feeling fullFeverNausea and vomitingLoss of appetiteDiarrheaInability to pass stool or gasLow urine outputThirstFatigueChillsJoint painDizziness or weakness Peritoneal dialysis, a procedure that helps remove waste from your body if your kidneys aren’t functioning correctly, is a common cause of peritonitis. In that case, you may also experience the following symptoms:Cloudy dialysis fluidWhite flecks, strands, or clumps (fibrin) in the dialysis fluid Premature babies with necrotizing enterocolitis (underdeveloped organs) are at an increased risk of peritonitis. They may show the following signs and symptoms, which usually develop in the first two weeks after birth:Bloating or swelling in the abdomenNot feeding wellFrequent vomiting that might be greenishBloody stool, constipation, or diarrheaA redness or abnormal color to the abdomenLack of energyFeverLow or unstable body temperature, slowed heart rate, or low blood pressurePauses in breathing (apnea) Causes of Peritonitis
Peritonitis is caused by a collection of blood, body fluids, or pus in the abdomen. There are two types of peritonitis: Spontaneous peritonitis is most often caused by an infection in fluid that collects inside the abdomen. The fluid buildup tends to occur with advanced liver or kidney disease, and in people who are on peritoneal dialysis for kidney failure. It can also be due to inflammation, infection, or injury of the intestines. Secondary peritonitis occurs due to another condition in the body, such as an infection that spreads from the digestive tract caused by a ruptured appendix, a stomach ulcer, diverticulitis, or a perforated colon. Injuries like gunshot or knife wounds can also bring about the infection, as well as the use of dialysis catheters or feeding tubes.Premature babies who have necrotizing enterocolitis may also be susceptible to secondary peritonitis. How Is Peritonitis Diagnosed
If you’re on peritoneal dialysis, your doctor may be able to diagnose peritonitis simply by your signs and symptoms, particularly if you are experiencing cloudy dialysis fluid. If your doctor needs further confirmation or if the infection may be a result of other medical conditions, your doctor will most likely perform a physical exam of your abdomen to feel if it is unusually tender or firm. Your healthcare provider may also conduct one or more of these tests: Peritoneal fluid analysis is done by using a thin needle to take a sample of the fluid in your peritoneum. An elevated white blood cell count in the fluid may indicate an infection or inflammation, and a culture of the fluid may also indicate if bacteria are present. Blood tests can also reveal if you have a high white blood cell count, and a blood culture can determine if there are bacteria in your blood.Imaging tests, such as an X-ray, ultrasound, or computerized tomography (CT) scan, can check for fluid, gas, masses, or abscesses in your abdomen or other perforations in your gastrointestinal tract. Duration of Peritonitis
If you have been diagnosed with peritonitis, you will need to be hospitalized for treatment. Typically, a course of antibiotics is given to get rid of the infection, which lasts 10 to 14 days. If you need further intervention, such as surgery, your doctor will discuss recovery time with you. Treatment and Medication Options for Peritonitis
Once the cause of peritonitis is identified, treatment should begin immediately. If left untreated, peritonitis can lead to severe, life-threatening conditions. Treatment may include antibiotics to help fight the infection and keep it from spreading.Emergency surgery may be used to remove infected tissue, treat the underlying cause of the infection, and prevent the infection from spreading. This is done when the cause is appendicitis, diverticulitis, or a perforated peptic ulcer. Other treatments, such as pain medications, intravenous (IV) fluids, supplemental oxygen, and a blood transfusion may be used if you are hospitalized for peritonitis. If you are on peritoneal dialysis, you may need to receive dialysis in another way until your body heals from the infection.If peritonitis persists or recurs, you may need to permanently switch to a different form of dialysis. Prevention of Peritonitis
When peritonitis is associated with peritoneal dialysis, it is often caused by germs around the catheter that is used to remove waste from the body. If you’re receiving peritoneal dialysis, there are steps you can take to prevent peritonitis. These include:Frequent hand washing, especially before touching the catheterCleansing skin around the catheter daily with an antisepticWearing a surgical mask when dialysis fluids are exchangedStoring supplies in a sanitary areaYour doctor may prescribe antibiotics as a preventive measure if you have a history of peritonitis or have peritoneal fluid buildup as a result of a medical condition like liver cirrhosis. Complications of Peritonitis
If left untreated, peritonitis can cause the following complications: DehydrationBacteremia, or a bacterial infection of the bloodstreamSepsis, a fast-moving and life-threatening condition in which the body’s response to an infection is out of balance, leading to inflammation over a large part of the bodyHepatic encephalopathy, the loss of brain function caused by the liver’s inability to remove toxins from the bloodHepatorenal syndrome, which occurs when there’s progressive kidney failure in people with cirrhosis of the liver Organ failure and death Research and Statistics How Many People Have Peritonitis
Little research exists examining the total number of peritonitis cases that occur each year. Still, a 2014 paper published in the journal Peritoneal Dialysis International suggests the rate of peritonitis associated with peritoneal dialysis has declined over the past few decades. According to the researchers, incidence of peritonitis in this patient population in the United States in the 1980s and early 1990s averaged 1.1 to 1.3 episodes per year of treatment. After the year 2000, many centers have reported 0.2 to 0.6 episodes per year of treatment.The researchers say the improvement in rates can be attributed to advances in technology in peritoneal dialysis, as well as standardization of antibiotic therapy. Related Conditions of Peritonitis
Certain conditions increase the risk of peritonitis, including necrotizing enterocolitis and being on peritoneal dialysis for kidney failure.Necrotizing enterocolitis is a serious intestinal disease in premature babies in which the lining of the intestinal wall becomes infected and inflamed. This can ultimately lead to the death of the tissue in the intestine. Treatment for the disease includes discontinuing feedings, removing air and fluid from the stomach and intestine, and administering intravenous fluids and antibiotics. In more severe cases, surgery may be needed to remove dead bowel tissue. Peritoneal dialysis is a treatment for kidney failure, a condition in which the kidneys lose the ability to function properly and cannot remove waste and balance fluids in the body. During peritoneal dialysis, a cleansing fluid flows through a catheter placed in the belly and the lining of the abdomen — called the peritoneum — acts as a filter to remove waste from the blood. These treatments can be done at home, at work, and even while traveling. Resources We Love
Favorite Organizations for Information on Peritonitis
National Kidney Foundation (NKF) NFK is a nonprofit organization dedicated to scientific research and innovation, as well as educating the public and advocating for all people with kidney disease. Get essential facts about peritonitis and find ways to get involved by volunteering or joining events to raise awareness and fundraise to fight kidney disease. Mayo Clinic The Mayo Clinic provides everything you need to know about causes, symptoms, treatment, and prevention of peritonitis. Favorite Online Support Group
Renal Support Network (RSN) RSN offers monthly virtual support group meetings via Zoom at no charge to people living with kidney disease and their families. Topics include diet, exercise, hobbies, and more. The organization also offers annual patient education meetings free of charge. Favorite Resource for Becoming an Advocate
Dialysis Patient Citizens (DPC) This nationwide, nonprofit organization is led by patients and provides a number of resources for dialysis and predialysis patients and their families. With DPC’s help you can volunteer to become a patient ambassador and represent the organization in your local community. DCP provides monthly newsletters, as well as multiple teleconference calls per year, with instructions for ways you can take action. This can range from writing a letter to inviting a local member of Congress to your facility. Additional reporting by Ashley Welch. Editorial Sources and Fact-Checking
Peritonitis. Medline Plus. November 3, 2020.Peritonitis: Symptoms & Causes. Mayo Clinic. June 18, 2020.Necrotizing Enterocolitis. Medline Plus. November 3, 2020.Peritonitis: Diagnosis & Treatment. Mayo Clinic. June 18, 2020.NHS. October 9, 2020.Johns Hopkins Medicine.Hepatorenal Syndrome. National Organization for Rare Disorders.Peritonitis Rates of the Past Thirty Years: From Improvement to Stagnation. Peritoneal Dialysis International. Mar-Apr 2014.Peritoneal Dialysis. Mayo Clinic. April 24, 2019.Show LessNEWSLETTERS Sign up for our Digestive Health Newsletter
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