Peritonitis

The inner wall of the abdomen and most of the abdominal organs are covered by a thin tissue known as the peritoneum. The peritoneum is made up of two parts: an outer layer called the parietal peritoneum, which is the membrane that covers the abdominal wall, and an inner layer called the visceral peritoneum, which is the tissue that covers the organs. Between these layers there is a space known as the peritoneal cavity, which is filled with a fluid that makes it possible for both layers of the peritoneum to slide.

When the peritoneum becomes inflamed or irritated, peritonitis occurs , a condition characterized by acute abdominal pain due to an accumulation of blood, fluid or pus due to various causes. This condition occurs very quickly, which is why symptoms do not take long to manifest. There are different types of this condition and you can learn about them all in this article about peritonitis: causes, symptoms, diagnosis and treatment.

Causes of peritonitis

Depending on the cause of peritonitis, this disease can be:

• Primary : This type of peritonitis is usually common in those who suffer from ascites , which is the excessive accumulation of fluid in the peritoneal cavity due to liver disease, cancer or heart failure. Ascites is more common in people with cirrhosis and kidney problems.
• Secondary : As its name implies, secondary peritonitis is caused by a primary condition such as perforation of the stomach or intestines, infection acquired during an operation, traumatic injuries, or the rupture of an abscess.
• Tertiary : It is less common and is caused by the passage of germs into the peritoneal cavity from the intestines. Typically, this peritonitis occurs in people with multiple organ failure.

What are the symptoms of peritonitis?

When the symptoms of peritonitis appear, the presence of the disease is imminent, since it is a condition that progresses rapidly and that must be treated in time to avoid major complications, such as death or infection of the whole organism. This disease usually manifests itself as follows:

• Abdominal pain : it is the most characteristic symptom and it occurs in a very acute way, it usually worsens when the abdomen is touched. The pain in the abdomen can be localized in different parts depending on the cause of the peritonitis, but when the infection has spread the discomfort can cover the entire abdomen. One way to detect that the pain is due to peritonitis is that it becomes much more intense when coughing or moving.
• Immobility : when peritonitis is of secondary cause, that is, there is some type of perforation or internal tear, the person usually remains totally immobile to prevent the pain from being much more bothersome. The abdomen in these people is very tense or hard to the touch. Tachycardia and excessive sweating also accompany the discomfort of secondary cause peritonitis.
• Other common symptoms : the symptomatological picture of peritotinis may also suggest the presence of fever , constipation , vomiting, gas, fatigue, shortness of breath, rapid heartbeat and decreased amount of urine. People with peritonitis from ascites may notice a bulge in their abdomen.

Types of peritonitis

Spontaneous Bacterial Peritonitis : It is the peritonitis caused due to spontaneous infection of the fluid in the peritoneal cavity. It is usually caused by cirrhosis of the liver and is not related to infection of other organs. It is common for those who suffer from this type of peritonitis to have renal phallus, fever, abdominal pain that worsens with touch, problems with brain function due to the accumulation of toxins in the brain, general malaise and fever. To diagnose this type of disease, it is necessary to examine the fluid present in the peritoneal cavity through a paracentesis. The presence of Escherichia coli or pneumococcus in said fluid would mean that the test result is positive for spontaneous bacterial peritonitis.

Secondary bacterial peritonitis : it is that peritonitis that occurs due to the accumulation of germs or bacteria in the peritoneal cavity derived from the pancreas, the bile duct, the gastrointestinal tract, the appendix, the urinary system or due to the perforation or wound in any of the viscera of the abdomen. This type of peritonitis can be produced by agents such as Escherichia coli or by gastric juices, bile, and blood. Abdominal swelling, fever, rapid heart rate, poor appetite, and abdominal pain that worsens with breathing are often the most noticeable symptoms of this type of peritonitis. To diagnose this disease it is necessary that the person has high leukocytesin blood, low pH of the organism and dilation of the intestinal loops on an abdominal radiograph. Computed tomography of the abdomen is the exam that will best help to obtain an effective diagnosis of secondary bacterial peritonitis.

Abscesses within the intestine : Peritonitis can be localized when it is caused by the presence of abscesses within the abdomen. The origin of these abscesses can be in an infection produced by the inflammation of the gallbladder, by the perforation of the intestines, by the infection acquired during a surgery or by a significant traumatic wound in the abdomen. Computed tomography is the best way to diagnose this type of peritonitis.

Diagnosis of peritonitis

In order to diagnose peritonitis, it is necessary to go to an emergency medical center where the health specialist will perform a physical examination, consult the symptoms of the affected person and order a series of blood tests and imaging tests to be carried out to deeply observe the abdomen and peritoneal cavity.

Blood tests are essential to corroborate the presence of an infection, which is usually corroborated due to a considerable increase in the values ​​of white blood cells or leukocytes. Likewise, it will be necessary to check the pH values ​​of the organism, the C-reactive protein and fibrogen. To detect any abdominal injury or variation in the peritoneal cavity, it is recommended to perform a computed tomography of the abdomen, a test that will allow diagnosing the cause of peritonitis, which can be an untreated appendicitis or a visceral injury.

In the case of peritonitis caused by ascites, it will be necessary to extract fluid from the peritoneal cavity to evaluate it through a paracentesis, a test that allows us to know the composition of said substance to know if it has bacteria or germs that may be causing said infection.

Treatment of peritonitis

The treatment of peritonitis will depend on the type of peritonitis that the person has. However, in most cases the procedure requires correcting the condition through surgical surgery and the consumption of antibiotics in order to reduce the bacteria causing the infection. Spontaneous primary peritonitis is usually treated mainly through special antibiotic medications that have been suggested by the culture subtraction of the accumulated fluid in the peritoneal cavity.

The other types of peritonitis, that is, secondary or tertiary peritonitis, must be treated as soon as possible in surgical surgery to correct the problem in time and avoid worse complications that can be fatal for the person. Since the bacteria that cause these types of peritonitis are often much more aggressive, antibiotic treatment is essential and the drugs used may be much stronger than those used to treat primary peritonitis.

Due to the seriousness that peritonitis represents for the health of the person, many individuals wonder what the prognosis of this disease is; Regarding this, we can say there is a great risk that people with primary peritonitis may have a relapse during the following 12 months after diagnosis. The mortality rate for secondary or tertiary peritonitis ranges between 10% and 40%, but this prognosis depends largely on the cause of the disease and the health status of the person suffering from this condition. The peritonitis that most result in mortality are those that are diagnosed late, at least 48 hours after its appearance.