Peritonitis – Symptoms and Causes

What Is Peritonitis?

Peritonitis is a serious medical condition. It occurs when the peritoneum—the thin tissue layer lining the inside of the abdomen—becomes inflamed. This inflammation typically results from a bacterial or fungal infection.

The condition affects the abdominal area, which is located between the chest and pelvis. Left untreated, peritonitis can quickly develop into a life-threatening situation as the infection may spread throughout the body.

Types of Peritonitis

There are two main types:

1. Spontaneous Bacterial Peritonitis: This infection occurs when bacteria enter the peritoneal cavity without an obvious source. It’s commonly seen in people with:
   • Liver disease (especially cirrhosis)
   • Kidney disease
2. Secondary Peritonitis: This type develops as a result of:
   • A rupture or hole in an abdominal organ
   • Other underlying health conditions

Peritoneal Dialysis and Infection Risk

People undergoing peritoneal dialysis for kidney failure face a higher risk of developing peritonitis. This treatment helps remove waste products from the blood when kidneys aren’t functioning properly.

To reduce infection risk, proper hygiene practices are essential:

• Washing hands thoroughly
• Cleaning the skin around the catheter
• Following all sterilization procedures before, during, and after dialysis

Treatment Approaches

Quick medical attention is crucial for successful treatment. Healthcare providers typically use:

• Antibiotics to fight bacterial infection
• Surgical procedures when necessary
• Treatment for any underlying conditions

Without prompt medical care, peritonitis can progress to widespread infection and potentially become fatal.

Signs and Symptoms

People with peritonitis may experience a range of symptoms that need prompt attention. These symptoms typically affect the abdominal area and can spread to cause whole-body effects.

Common symptoms include:

• Pain or tenderness in the belly area
• Abdominal bloating or fullness feeling
• Elevated body temperature
• Nausea and vomiting
• Reduced hunger
• Loose stools
• Decreased urine output
• Increased thirst
• Inability to pass gas or stool
• Unusual fatigue
• Mental confusion

For individuals receiving peritoneal dialysis, additional warning signs may appear:

• Cloudy appearance of dialysis fluid
• White specks, strands, or clumps (fibrin) in the dialysis solution

When Medical Care Is Needed

Peritonitis requires immediate medical attention as it can become life-threatening quickly. Contact your healthcare provider right away if you experience severe abdominal pain or swelling along with:

• Fever
• Stomach upset and vomiting
• Low urine output
• Excessive thirst
• Constipation or inability to pass gas

If you use peritoneal dialysis, call your doctor immediately if your dialysis fluid:

• Appears cloudy or discolored
• Contains white particles
• Shows strands or clumps
• Has an unusual odor, especially with color changes or pain around your catheter

Seek emergency care if you have intense abdominal pain that prevents you from finding a comfortable position.

Call 911 if you experience severe belly pain following an accident or injury, as peritonitis can develop after abdominal trauma or a ruptured appendix.

Causes

Peritoneum infection typically results from a hole or rupture in an abdominal organ, most commonly the stomach or colon. While other causes exist, they are uncommon.

Several situations can lead to peritonitis:

Medical Procedures

• Infections during peritoneal dialysis from unclean environments, poor hygiene, or contaminated equipment
• Complications following digestive surgeries
• Feeding tube insertions gone wrong
• Procedures to remove abdominal fluid (particularly in liver disease patients)
• Rare complications from colonoscopies or endoscopies

Digestive System Ruptures

• Burst appendix
• Perforated stomach ulcers
• Holes in the colon

These ruptures allow bacteria to enter the peritoneum through breaks in the digestive tract lining.

Inflammatory Conditions

• Pancreatitis: When pancreas inflammation becomes infected, bacteria can spread beyond the organ and cause peritonitis.
• Diverticulitis: Infected pouches in the intestinal wall may rupture, spilling intestinal waste into the abdomen.

Physical Trauma

Injuries to the abdomen can create pathways for bacteria or harmful chemicals to enter the peritoneum from other body areas.

Spontaneous Bacterial Peritonitis

This form occurs without any obvious tear or hole. It most commonly affects people with advanced liver disease, particularly cirrhosis. The condition causes fluid buildup in the abdomen, creating an environment where bacterial infection can develop.

The body’s protective peritoneum membrane becomes compromised in all these scenarios, allowing harmful substances to enter a normally sterile space. Once bacteria or other irritants penetrate this barrier, inflammation begins rapidly, triggering the painful and potentially dangerous condition of peritonitis.

Risk Factors

Several factors can increase your chance of developing peritonitis:

Medical Treatments

• Peritoneal dialysis treatment

Underlying Health Conditions

• Liver cirrhosis
• Appendicitis
• Stomach ulcers
• Diverticulitis
• Crohn’s disease
• Pancreatitis

Previous Infection

If you’ve had peritonitis before, you may face a higher risk of getting it again compared to someone who has never had this infection.

Complications

If peritonitis goes untreated, it can lead to a serious condition called sepsis. Sepsis occurs when the infection spreads throughout the body via the bloodstream. This widespread infection can cause:

• Dangerously low blood pressure (shock)
• Failure of vital organs
• Death in severe cases

Prompt medical treatment is essential to prevent these life-threatening complications.

Preventing Peritonitis

If you receive peritoneal dialysis, you can take several steps to lower your risk of getting peritonitis:

Daily Hygiene Practices:

• Wash hands thoroughly before handling your catheter.
• Clean under fingernails and between fingers.
• Use antiseptic to clean the skin around your catheter every day.
• Keep all supplies in a clean area.
• Wear a surgical mask during fluid exchanges.

Medical Prevention Approaches:

1. Talk with your dialysis team about proper catheter care.
2. Your doctor might prescribe antibiotics if you’ve had peritonitis before.
3. Antibiotics may also be recommended if you have fluid buildup from conditions like liver cirrhosis.
4. You might need to stop taking proton pump inhibitors.

Germs near the catheter often cause this infection, so good catheter care is essential. Following these steps helps protect your health during dialysis treatment.