Peritonitis is inflammation of the peritoneum, the thin membrane that lines the inner abdominal wall and abdominal organs. This inflammation is generally caused by a bacterial or fungal infection.If left untreated, infection in peritonitis can spread to the whole body.
Normally, the peritoneum is clean of microorganisms. This layer serves to support the organs in the abdominal cavity and protect them from infection. However, under certain conditions or if there are diseases or problems in the digestive tract, the peritoneum can become inflamed.
Based on the origin of infection, peritonitis is divided into two, namely:
- Primary (spontaneous) peritonitis, which occurs as a result of direct bacterial or fungal infection of the peritoneum
- Secondary peritonitis, which occurs when bacteria or fungi from within the digestive system organs enter the peritoneum due to a pre-existing condition
Causes of Peritonitis
Primary peritonitis most often occurs due to cirrhosis of the liver accompanied by a buildup of fluid in the abdominal cavity (ascites). However, other conditions that can also cause ascites, such as heart or kidney failure, can also cause primary peritonitis.
In addition, the medical procedure of dialysis for kidney failure performed by inserting fluid into the abdominal cavity (CAPD) is also a common cause of primary peritonitis.
Meanwhile, secondary peritonitis usually occurs due to a tear or hole in the digestive tract. The following are some conditions that can increase the risk of secondary peritonitis:
- Injuries to the abdomen, for example from stabs or gunshots
- Appendicitis, diverticulitis, or peptic ulcers that can rupture or tear
- Cancer in the digestive tract or organs, such as the liver and colon
- Inflammation of the pancreas (pancreatitis)
- Pelvic inflammatory disease
- Inflammation in the digestive tract, such as Crohn's disease
- Infections of the gallbladder, small intestine, or bloodstream
- Surgery on the abdominal cavity
- Use of feeding tube
Symptoms of Peritonitis
Symptoms commonly experienced by people with peritonitis include:
- Abdominal pain that gets worse when you move or touch it
- Bloated
- Nausea and vomiting
- Fever
- Weak
- Decreased appetite
- Constantly feeling thirsty
- Diarrhea
- Constipation and can't pass gas
- The amount of urine that comes out is small
- Heart beat
When to go to the doctor
Immediately consult a doctor if you experience the above symptoms, especially if you have unbearable abdominal pain and have recently suffered an abdominal injury.
In patients with kidney failure who are undergoing dialysis through the stomach, notify the doctor if the fluid drained from the abdominal cavity shows the following signs:
- cloudy color
- Contains white spots
- There are strands or lumps
- Smells bad, especially if the area of skin around the catheter is red and painful
Peritonitis Diagnosis
In diagnosing, the doctor will first ask the patient's symptoms and medical history. After that, the doctor will perform a physical examination by pressing the patient's abdomen, which may cause discomfort.
To strengthen the diagnosis as well as look for possible causes of peritonitis, the doctor will carry out supporting examinations, such as:
- Complete blood count examination, to see signs of infection and inflammation
- Blood culture, to find out if the bacteria have spread to the bloodstream
- Urine examination, to make sure there are no problems with the kidneys
- Imaging tests with X-rays or abdominal CT scans, to check for holes or tears in the digestive tract
- Analysis of peritoneal fluid samples (paracentesis), to see if there are signs of infection or inflammation
- Peritoneal fluid culture, to determine the type of microorganism that causes infection
In patients undergoing CAPD, doctors can confirm peritonitis by looking at the color of the fluid that comes out of the peritoneum.
Peritonitis Treatment
Peritonitis is a serious condition that must be treated immediately, especially if the patient has cirrhosis. Based on research, the percentage of deaths due to peritonitis in patients with cirrhosis reached 40%, while the percentage of deaths due to secondary peritonitis was in the range of 10%.
Patients with peritonitis must be hospitalized. Some of the treatment methods for patients are:
- Giving antibiotics or antifungal drugs through an IV, to treat infections and prevent infection from spreading throughout the body
- Surgical procedures to remove infected tissue, close internal tears, and prevent the spread of infection
- Giving pain medication, oxygen, or blood transfusion, depending on the symptoms experienced by the patient
In patients undergoing CAPD, the doctor will inject the drug directly into the peritoneal cavity, through a pre-installed catheter. Patients are also advised to stop CAPD activity and replace it with regular dialysis for a while, until the patient recovers from peritonitis.
Peritonitis Complications
If not treated immediately, infection in the peritoneum can spread to the bloodstream and cause damage to a number of organs. Some of the complications that may arise from peritonitis are:
- Hepatorenal syndrome, i.e. progressive kidney failure
- Sepsis, which is a severe reaction due to bacteria that have entered the bloodstream
- Hepatic encephalopathy, which is a loss of brain function due to the liver not being able to filter toxins from the blood
- Abscess or collection of pus in the abdominal cavity
- Intestinal tissue death
- Intestinal adhesions that can cause intestinal obstruction
- Septic shock, which is characterized by a drastic and very dangerous drop in blood pressure
Peritonitis Prevention
Prevention of peritonitis depends on the patient's condition. In patients suffering from cirrhosis and ascites, the doctor will prescribe antibiotics. While in patients undergoing CAPD, there are several ways that can be done to prevent peritonitis, namely:
- Wash hands thoroughly before touching the catheter
- Clean the skin around the catheter with antiseptic every day
- Store CAPD equipment in a hygienic place
- Wear a mask during the CAPD process
- Learn techniques for caring for a CAPD catheter from a nurse