Understanding Peritonitis: Causes and Treatments

Peritonitis is a serious medical condition characterized by inflammation of the peritoneum, the thin layer of tissue lining the inside of the abdomen and covering most abdominal organs. This condition is often a medical emergency requiring prompt diagnosis and treatment to prevent severe complications and death.

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What is Peritonitis?

Peritonitis occurs when the peritoneum becomes inflamed, typically due to an infection. This inflammation can result from various causes, including spontaneous bacterial peritonitis (SBP), a perforation in the gastrointestinal tract, or the spread of cancer within the peritoneal cavity, known as peritoneal carcinomatosis.

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Types of Peritonitis

Spontaneous Bacterial Peritonitis (SBP)

Spontaneous bacterial peritonitis is an infection of the peritoneal fluid without an apparent source. SBP commonly occurs in patients with liver cirrhosis and ascites. The bacteria most frequently responsible for SBP include Escherichia coli and Klebsiella pneumoniae.

Perforation Peritonitis

Perforation peritonitis arises when there is a rupture in the gastrointestinal tract, allowing contents to leak into the peritoneal cavity. This can result from conditions such as peptic ulcer disease, diverticulitis, or appendicitis. The leaked contents can include bacteria, partially digested food, and feces, all of which can cause severe infection and inflammation.

Secondary Peritonitis

Secondary peritonitis is typically the result of another underlying condition, such as a ruptured appendix, gastric ulcer, or traumatic injury. The bacterial infection spreads from the primary site to the peritoneal cavity, leading to inflammation.

Peritoneal Carcinomatosis

A peritoneal carcinomatosis is a form of cancer that spreads within the peritoneal cavity. This condition is often secondary to primary cancers such as ovarian, colorectal, or gastric cancer. The spread of cancer cells within the peritoneum can lead to severe inflammation and the accumulation of malignant ascites.

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Causes of Peritonitis

Infection

The most common cause of peritonitis is infection. This can occur spontaneously, as in SBP, or secondary to a gastrointestinal perforation. Bacteria can enter the peritoneal cavity through a perforated bowel, ruptured appendix, or other gastrointestinal tract disruptions.

Chemical Irritation

Chemical peritonitis can result from the leakage of sterile irritants such as gastric acid, bile, or pancreatic enzymes into the peritoneal cavity. These substances can cause severe inflammation and tissue damage even in the absence of infection.

Injury or Trauma

Injuries or surgical procedures that penetrate the abdominal cavity can introduce bacteria or foreign substances, leading to peritonitis. Traumatic injuries, such as gunshot wounds or stab wounds, are also potential causes.

Underlying Medical Conditions

Certain medical conditions increase the risk of developing peritonitis. These include liver cirrhosis, chronic kidney disease requiring peritoneal dialysis, and inflammatory bowel diseases like Crohn's disease and ulcerative colitis.

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Symptoms of Peritonitis

Peritonitis presents with a range of symptoms, which can vary in severity. Common symptoms include:

The severity and combination of symptoms depend on the underlying cause and extent of the inflammation. In severe cases, peritonitis can lead to septic shock, characterized by low blood pressure, rapid heart rate, and organ failure.

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Diagnosis of Peritonitis

Clinical Examination

Diagnosis begins with a thorough clinical examination. The physician will assess the patient's medical history, symptoms, and physical signs, such as abdominal tenderness and distension.

Laboratory Tests

Laboratory tests, including blood tests, can help identify markers of infection and inflammation. Elevated white blood cell counts and increased levels of C-reactive protein (CRP) are common indicators.

Imaging Studies

!Abdominal CT scan()

Imaging studies, such as abdominal X-rays, ultrasound, and computed tomography (CT) scans, provide detailed images of the abdominal cavity. These studies can help identify the source of infection, fluid accumulation, and any perforations or abscesses.

Peritoneal Fluid Analysis

For patients with ascites, a sample of peritoneal fluid may be obtained through paracentesis. The fluid is analyzed for the presence of bacteria, white blood cells, and other indicators of infection or malignancy. This analysis is crucial for diagnosing spontaneous bacterial peritonitis.

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Treatment of Peritonitis

Antibiotic Therapy

The cornerstone of peritonitis treatment is antibiotic therapy. Broad-spectrum antibiotics are typically administered initially to cover a wide range of potential bacteria. Once the specific causative organism is identified, the antibiotic regimen may be adjusted accordingly.

Surgical Intervention

In cases of perforation peritonitis or secondary peritonitis, surgical intervention is often necessary to repair the underlying cause and remove infected material. This may involve procedures such as appendectomy, bowel resection, or drainage of abscesses.

Drainage of Peritoneal Fluid

For patients with significant fluid accumulation in the peritoneal cavity, drainage may be required to relieve symptoms and reduce the risk of further infection. This can be performed through percutaneous catheter drainage or surgical intervention.

Management of Underlying Conditions

Effective treatment of peritonitis also involves addressing the underlying conditions that contribute to the inflammation. For example, patients with liver cirrhosis may require diuretics to manage ascites, while those with inflammatory bowel disease may need immunosuppressive therapy.

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Complications of Peritonitis

Peritonitis can lead to severe complications if not promptly diagnosed and treated. Potential complications include:

Early recognition and treatment are essential to prevent these life-threatening complications.

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Prevention of Peritonitis

Preventing peritonitis involves managing risk factors and underlying conditions effectively. Strategies include: