Infections and Inflammations
An infection is the condition of multiplication of parasitic organisms or microorganisms within the body. An inflammation is the reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent. Many people use the terms interchangeably since they have several symptoms in common and usually are treated similarly.
Peritonitis is an inflammation of the peritoneum, which is the membrane that lines the wall of the abdomen and covers the abdominal organs.
Causes, incidence and risk factors
Types of peritonitis include:
- Spontaneous Peritonitis - an infection that occurs as a complication of ascites (a collection of fluid in the peritoneal cavity), which is usually related to liver or kidney failure
- Secondary Peritonitis - caused by another condition, most commonly the spread of an infection from the digestive organs or bowels
- Dialysis associated Peritonitis - This is an acute or chronic inflammation (irritation and swelling) of the peritoneum (lining of the abdominal cavity) that occurs in people receiving peritoneal dialysis
An intra-abdominal abscess (abdominal abscess) is a condition which involves a collection of pus in the abdomen and may cause peritonitis. Before peritonitis develops, it can still cause symptoms that are similar or identical to peritonitis.
An intra-abdominal abscess may arise following:
- Localization of peritonitis
- Gastrointestinal perforation
- Anastomotic leak after bowel or stomach surgery
- Hematogenous (bloodstream) spread
They develop in sites of gravitational drainage such as:
- Subhepatic spaces
- Subphrenic spaces
- Paracolic gutters
- Abdominal pain, which increases with movement
- Abdominal tenderness
- Abdominal distension
- Low urine output
- Point tenderness
- Fluid in the abdomen (ascites)
- Inability to pass feces gas
- Signs of shock in extreme cases
- Physical examination and medical history
- Blood tests including blood culture and X-rays or CT scans may be ordered
- Peritoneal fluid analysis (paracentesis) & culture
The cause must be identified and treated promptly.
Treatment typically involves fluid infusion to control shock, surgery to drain the peritoneal cavity and repair the cause, and antibiotics to deal with the infection. In cases associated with peritoneal dialysis, antibiotics may be infused through the dialysis catheter, but if the infection is severe, the catheter itself must often be removed.
Course of Illness
The outcome is often good with treatment, but can be poor without treatment. Sometimes the outcome is poor even with prompt and adequate treatment.
Peritonitis can be life-threatening and cause a number of different complications, depending on the type.
Complications may include
- Peritonitis stops the movement of bowel contents (peristalsis), which can block the bowel (paralytic ileus)
- Septic shock - Fluid from the blood accumulates in the abdominal cavity and the loss of fluid from the circulation may also cause shock
- Intraperitoneal adhesions