Peritonitis (peritonitis)

Peritonitis is very often life-threatening emergencies that need immediate attention in an intensive care unit.

Peritonitis (peritonitis)

Synonyms

Peritonitis, peritonitis

definition

Examination of the cecum

Peritonitis is referred to by physicians as peritonitis. They distinguish a local and a diffuse (generalized) form. Peritonitis is strictly speaking not a disease of its own but the result of other diseases.

In addition, there is the so-called pseudo- or sham peritonitis. This occurs, for example, during a diabetic coma, an Addison crisis in adrenocortical insufficiency or in metabolic diseases such as acute intermittent porphyria.

Usually the abdominal space is free from pathogens. But if, for example, bacteria get into the free abdominal space, they can implant themselves in the peritoneum. There they cause a severe inflammation. Without timely treatment, the pathogens reach the organism via the numerous supply routes and cause blood poisoning. This sepsis is fatal without intensive care (detailed information: see sepsis).

By far the most common cause of peritonitis is appendicitis. But many other diseases of the internal organs can cause bacteria to enter the abdominal area (see Causes). In addition, germs can penetrate from the outside into the abdomen. This is most often the case with a dialysis treatment through the abdominal wall (peritoneal dialysis).

Function of the peritoneum

The peritoneum on the one hand clothes the inside of the abdominal wall. This part is called parietal peritoneum. On the other hand, it spans the stomach, liver, biliary tract, pancreas, intestine, uterus and ovaries. This part of the peritoneum is called mediteranean peritoneum viscerale. The peritoneum is traversed by numerous blood and lymphatic vessels as well as nerves that supply the organs or the abdominal wall. In addition, it produces a liquid that reduces the frictional resistance under the organs.

frequency

In Germany, the number of peritoneal infections has fluctuated by 10,000 cases per year for many years. For example, in 2015 the Federal Statistical Office recorded more than 10,500 cases of peritonitis. In 2012 it was a good 9,500 cases. The mortality rate is about 10 percent.

symptoms

Physicians distinguish between localized and extensive (diffuse or generalized) peritonitis. Common symptom of both forms are severe abdominal pain. The pain is usually so severe that those affected can hardly move and take restraint. In addition, the abdominal wall is usually very hard and tense.

Symptoms of local peritonitis

Typically, abdominal pain is limited to the affected area of ​​the peritoneum with local peritonitis. Strong abdominal pain and defensive tension in the area of ​​the right lower abdomen indicate appendicitis as the cause.

Mild fever, nausea or constipation are typical accompanying symptoms of local peritonitis.

Symptoms of diffuse peritonitis

The symptoms of diffuse peritonitis are usually significantly more severe than in the local form. The pain is stronger and the stomach tense. Almost always, generalized peritonitis is accompanied by intestinal obstruction (ileus). Among other things, the intestinal obstruction can be recognized by the lack of natural intestinal movement (intestinal peristalsis) and the barely perceptible bowel sounds and stool behavior. Doctors refer to this symptomatology of "acute abdomen". This disease is also formally written in the affected person's face: Her face is sunken, gray and looks pointed. Doctors refer to this as Facies hippocratica.

In addition, there are sometimes violent accompanying symptoms such as

  • high fever with chills and cold sweat
  • accelerated heartbeat and low blood pressure
  • unrest
  • Drowsiness until shock
  • Nausea with vomiting
  • Diarrhea, constipation.

Severe abdominal pain and sudden fever are strong signs of serious illness. If you experience these symptoms, you should urgently call an ambulance or go to the hospital as soon as possible.

Symptoms of CAPD peritonitis

If people with kidney disease are treated with peritoneal dialysis, CAPD peritonitis can occur. CAPD stands for "continuously ambulatory peritoneal dialysis". In this form of peritonitis the typical symptoms are usually much milder. Sometimes they even go unnoticed.

causes

Peritonitis is caused by bacteria. By far the most common cause (50 percent) are infections with the intestinal bacterium Escherichia coli. Streptococci and enterococci account for a good third of peritonitis. Klebsiella have a share of about 10 percent.

For bacteria to cause peritonitis, they first have to enter the abdomen. This is the big exception for healthy people. 95 percent of all peritoneal infections are a complication of the following diseases:

  • Appendicitis (appendicitis) with appendectomy
  • broken stomach ulcers and intestinal ulcers or intestinal mucosal deposits (so-called diverticula)
  • Biliary and gallbladder inflammations
  • pancreatitis
  • Inflammation of the female reproductive organs
  • bacterial urinary tract infections
  • abscesses
  • Lymph node reparations (rare)
  • bowel obstruction
  • Peritoneal tumors
  • Intestinal invaginations (invaginations, very rare).

The remaining 5 percent of peritoneal inflammations refer to surgical procedures (including peritoneal dialysis), umbilical infections or unexplained causes.

examination

The first suspicion of the diagnosis peritonitis usually wake the typical appearance of the patient, the strong abdominal pain even at the slightest touch and a palpation of the abdominal wall. However, safety first creates imaging processes. This is primarily the ultrasound examination. Evidence of peritonitis may be followed by an X-ray, computed tomography (CT) or magnetic resonance imaging (MRI). In addition, blood is taken in order to determine, among other things, the inflammation.

If the suspected diagnosis has been confirmed, immediate surgery should be performed. Sometimes the causative agent of peritonitis is determined beforehand. In a so-called ascites puncture, ascites is drawn out of the abdomen with a hollow needle.

treatment

In rare cases, local peritonitis can be medically treated with antibiotics. As a rule, however, a quick operation with subsequent intensive medical treatment is unavoidable.

The type of surgery depends on the cause and extent of peritonitis. Basically, operations are best done before large volumes of infectious material are poured into the abdomen. Therefore, for example, a severely inflamed cecum is, if possible, removed before the breakthrough. This also applies to inflamed intestinal sections or extensive gall bladder inflammations.

If, for example, the cecum is already broken through, if intestinal contents or pus from abscesses or other ulcers has poured into the abdomen, a quick operation is especially urgent.

  • In principle, the operations in abdominal surgery follow the following pattern:
  • Clearing out the inflammatory focus
  • Elimination or supply of the causative organ
  • Removal of dead tissue, pus and fibrin deposits
  • Restoration of an asymptomatic abdominal cavity by leaching with saline solution (lavage)
  • if necessary: ​​setting of drains over which wound secretions can flow outward after the operation.

After the operation, patients receive intensive care as needed.

forecast

In the overall view of all peritonitis, the mortality rate (mostly due to sepsis) is 10 percent. In fact, the mortality varies depending on the cause of peritonitis. So run 95 percent of all local peritonitis by appendicitis without complications. Diffuse peritonitis, on the other hand, is fatal in about 30 percent of cases. In the process, around half of those affected die despite the successful operation of the consequences of the bacterial infection.

prevention

For healthy people, prevention of peritonitis is not possible. Diseases that increase the risk of peritonitis (see Causes) should be treated consistently. Pronounced adherence and regular visits to the doctor's office may help to reduce the risk of peritonitis or prevent complications from early diagnosis.

Severe abdominal pain and sudden onset of fever are warning signs. For these symptoms, you should immediately contact an ambulance or see a doctor.

Peritonitis (peritonitis)

FAQ - 💬

❓ What are 4 signs of peritonitis?

👉 Signs and symptoms of peritonitis include: Abdominal pain or tenderness....Contact your doctor immediately if you have severe pain or tenderness of your abdomen, abdominal bloating, or a feeling of fullness associated with:

  • Fever.
  • Nausea and vomiting.
  • Low urine output.
  • Thirst.
  • Inability to pass stool or gas.

❓ What is peritonitis caused by?

👉 What causes peritonitis? Peritonitis is caused by an infection. Bacteria can enter the lining of your belly from a hole in your GI (gastrointestinal) tract. This can happen if you have a hole in your colon or a burst appendix.

❓ What are the three types of peritonitis?

👉 Primary peritonitis is most often spontaneous bacterial peritonitis (SBP) seen mostly inpatients with chronic liver disease. Secondary peritonitis is by far the most common form of peritonitis encountered in clinical practice. Tertiary peritonitis often develops in the absence of the original visceral organ pathology.

❓ How long does it take to recover from peritonitis?

👉 If you're diagnosed with peritonitis, you'll need treatment in hospital to get rid of the infection. This might take 10 to 14 days.

❓ How quickly does peritonitis develop?

👉 How fast does peritonitis develop? Peritonitis is a medical emergency that requires prompt medical attention, as it develops very rapidly. Upon rupture of the abdominal wall or abdominal organs, the peritoneum can become infected within 24 to 48 hours.

❓ What is the most common complication of peritonitis?

👉 Enterocutaneous fistulas, surgical site infection, sepsis, and multiorgan failure are the commonest complications seen in surgical settings. Others include abdominal compartment syndrome, wound dehiscence, and respiratory insufficiency.

❓ How is peritonitis diagnosed?

👉 To diagnose peritonitis, your doctor will talk with you about your medical history and perform a physical exam. When peritonitis is associated with peritoneal dialysis, your signs and symptoms, particularly cloudy dialysis fluid, may be enough for your doctor to diagnose the condition.

❓ What type of bacteria causes peritonitis?

👉 Escherichia coli, streptococci (mostly pneumococci), and Klebsiella cause most episodes of spontaneous bacterial peritonitis in patients who are not receiving selective intestinal decontamination (Garcia-Tsao 1992).

❓ How many stages of peritonitis are there?

👉 Peritonitis can usually be divided into an early formative or absorptive stage during which bacteriemia and bacterial toxemia preponderate, and the fully developed later stage in which circulatory disturbances and inhibition ileus preponderate.

❓ What antibiotic is used for peritonitis?

👉 Commonly used antibiotics for the treatment of peritonitis include beta-lactams (penicillins), carbapenems (beta-lactamase−resistant beta-lactams), cephalosporins (semi-synthetic beta-lactams), and quinolones (such as ciprofloxacin).

❓ How does peritonitis cause death?

👉 Peritonitis is usually caused by infection from bacteria or fungi. Left untreated, peritonitis can rapidly spread into the blood (sepsis) and to other organs, resulting in multiple organ failure and death.

❓ What is peritonitis and what causes it?

👉 Peritonitis is inflammation of the peritoneum, the thin layer of tissue covering the inside of your abdomen and most of its organs. The inflammation is usually the result of a fungal or bacterial infection.

❓ Why is it important to treat peritonitis quickly?

👉 This condition can be caused by infectious agents, including bacteria and fungi. It is important to treat peritonitis quickly to prevent any infection from spreading to other parts of the body. What is peritonitis? The peritoneum is the thin tissue that lines the inside of your abdomen (belly) and covers the abdominal organs.

❓ Is peritonitis life threatening?

👉 Peritonitis is typically caused by an infection involving gastrointestinal or pelvic organs, and it can be life threatening if left untreated. Can peritonitis lead to sepsis?

❓ What is peritonitis and abdominal sepsis?

👉 Peritonitis and Abdominal Sepsis. Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF more... Background. Peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein.


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