Peritonitis

Peritonitis is inflammation of the membranes of the abdominal wall and organs.

Peritonitis is a life-threatening emergency that needs prompt medical treatment

The abdominal organs, such as the stomach and liver, are wrapped in a thin, tough membrane called the visceral peritoneum.

The abdominal walls are similarly lined (parietal peritoneum). A protective layer of fat contained in a membrane (the omentum) sits between the organs and the abdominal wall. Lubricating fluid allows all these membranes to slide smoothly over each other.

The main function of the peritoneum is to permit free movement of the internal organs during digestion. Peritonitis is inflammation of the peritoneum caused by bacterial infection.

The symptoms of peritonitis include: Shock

Peritonitis may be classed as spontaneous peritonitis or secondary peritonitis. The symptoms of spontaneous peritonitis are often less dramatic than secondary peritonitis. Spontaneous peritonitis can occur in patients with severe liver disease, heart disease or kidney disease.

Often these diseases cause the accumulation of fluid within the abdominal cavity.

This is called ascites

The presence of ascites, together with the person’s weakened defences against infection, often leads to bacterial infection. The main cause of secondary peritonitis is the escape of pus from an infected abdominal organ, including: – a severe, untreated ulcer can sometimes burn through the wall of the stomach or duodenum, allowing digestive juices and food to leak into the abdominal cavity. – the intestines can be damaged and perforated by a range of conditions, including diverticulitis and inflammatory diseases such as Crohn’s disease.

– the appendix is a thin tail growing out of the large intestine. Food or faecal matter can sometimes lodge inside the appendix and become infected with bacteria. – this small sac stores bile from the liver.

A severe infection (cholecystitis) can cause the gall bladder to burst. – an inflamed pancreas can directly cause inflammation in the abdomen, which may be very severe.

The two major causes of pancreatitis are alcoholism and gallstones

– the fertilised egg lodges and grows inside the slim fallopian tube instead of the uterus. The tube ruptures in around one out of five cases. – inflammation of the fallopian tube. Sometimes, the tube becomes distended with pus until it bursts.

Peritonitis is life threatening without prompt medical treatment

The infection stops the normal movements of the intestines (peristalsis). The body quickly becomes dehydrated, and important chemicals called electrolytes are dangerously disturbed. The internal organs – such as lungs, kidneys and liver – may fail.

A person with untreated peritonitis can die within a few days. Diagnosing peritonitis involves a number of tests, including: – the abdomen is hard and painful.

There are no bowel movements or sounds

– a sample of fluid is taken and examined for signs of infection. Treatment options for peritonitis depend on the cause, but may include: – such as a perforated ulcer. Adhesions are bands of scar tissue that result from previous inflammation (such as peritonitis) or surgery.

They can occasionally cause strangulation and obstruction to the bowel (bowel obstruction). In some cases, surgery may be required to cut the adhesions. Symptoms of peritonitis Severe and constant abdominal pain Fever Inability to break wind or pass stools Nausea and vomiting Spontaneous peritonitis and secondary peritonitis Causes of secondary peritonitis Perforated ulcer Perforated bowel Burst appendix Perforated gall bladder Pancreatitis Ectopic pregnancy Salpingitis Abdominal surgery Necrotising enterocolitis Blood infection Dialysis Stab wound The infection can be fatal Diagnosis of peritonitis Physical examination Signs of shock Blood tests X-rays Laparoscopy Peritoneal fluid culture Treatment for peritonitis Hospitalisation – often in an intensive care unit Antibiotics – tailored to the specific bacteria to kill the infection Intravenous fluids – to rehydrate the body and replace lost electrolytes Surgery – to repair the ruptured organ and wash out the abdominal cavity of blood and pus Treatment for the underlying cause Adhesions often follow peritonitis Where to get help Your doctor Hospital emergency department In an emergency, call 911.

Key Points

• Peritonitis is a life-threatening emergency that needs prompt medical treatment
• main function of the peritoneum is to permit free movement of the internal organs during digestion
• Peritonitis is inflammation of the peritoneum caused by bacterial infection
• symptoms of peritonitis include: Shock
• symptoms of spontaneous peritonitis are often less dramatic than secondary peritonitis