Understanding the Peritoneum
Before delving into what happens during peritonitis, it is crucial to understand the peritoneum itself. The peritoneum is a thin, two-layered membrane that lines the inner wall of the abdomen and covers the abdominal organs, such as the stomach, liver, and intestines. A small amount of sterile fluid separates these two layers, allowing the organs to glide smoothly against each other during movement. When this delicate environment is breached by an infection or irritating substance, the body's immune response triggers inflammation, leading to the condition known as peritonitis.
Recognizing the Symptoms of Peritonitis
Peritonitis is not subtle and often presents with unmistakable and severe symptoms that worsen rapidly. Prompt recognition is key to a favorable outcome. The most common and prominent symptom is severe abdominal pain that may initially be dull and poorly localized but quickly becomes sharp and widespread. Movement, coughing, or even light pressure can exacerbate the pain. Other critical signs include:
- Abdominal bloating or distention
- Fever and chills
- Nausea and vomiting
- Loss of appetite
- Feeling tired or excessive fatigue
- Difficulty passing gas or having a bowel movement
- Rapid heartbeat and low blood pressure, signs of potential shock
- Cloudy dialysis fluid (for those on peritoneal dialysis)
The Root Causes: Why the Peritoneum Becomes Inflamed
Peritonitis is almost always caused by an underlying infection or injury that allows bacteria or irritating fluids to enter the abdominal cavity. The causes are typically categorized into primary and secondary forms.
Primary Peritonitis
Also known as spontaneous bacterial peritonitis (SBP), this form occurs most often in people with advanced liver disease, such as cirrhosis, who develop a condition called ascites. Ascites is the buildup of fluid in the abdominal cavity, which can become infected without any clear external source of infection.
Secondary Peritonitis
This is the most common type and results from a rupture or infection spreading from an organ within the abdomen. Common causes include:
- Perforated Appendix: A ruptured appendix is a classic cause of secondary peritonitis.
- Ruptured Diverticulitis: Small pouches in the colon, if they rupture, can leak bacteria.
- Stomach or Intestinal Ulcer: A perforated peptic ulcer can release stomach acid and contents into the abdomen.
- Surgical Contamination: Bacteria can be introduced during abdominal surgery, though modern techniques have reduced this risk.
- Trauma: A knife wound or other injury can cause a breach that allows bacteria to enter the peritoneum.
- Peritoneal Dialysis: A less common but serious complication for individuals using this form of dialysis, where bacteria enter through the catheter.
- Pancreatitis: Inflammation of the pancreas can release fluids that irritate the peritoneum.
Diagnosis and Assessment
Diagnosing peritonitis is an urgent process based on a combination of a physical exam, medical history, and various tests. During the physical exam, a healthcare provider will check for a tender, bloated, or rigid abdomen. Other diagnostic tools include:
- Blood tests: To check for signs of infection, such as an elevated white blood cell count.
- Imaging: X-rays, CT scans, and sometimes ultrasounds can help identify the source of the infection, such as a perforated organ or a collection of pus.
- Paracentesis: A procedure where a small amount of fluid is removed from the abdomen with a needle and tested for infection.
Treatment Options and Medical Intervention
Peritonitis requires immediate hospitalization and aggressive medical treatment to resolve the underlying cause and prevent further complications. Treatment is often multidisciplinary and may include:
- Antibiotics: Intravenous (IV) antibiotics are typically administered immediately to fight the infection.
- Surgery: Many cases of peritonitis, especially secondary peritonitis, require emergency surgery to repair the underlying cause, such as a burst appendix or ulcer.
- Supportive Care: Intravenous fluids, pain medication, and other supportive treatments are provided to manage symptoms and complications.
- Abscess Drainage: If localized pockets of pus (abscesses) have formed, they may need to be drained.
For further authoritative information on this emergency, consult the Mayo Clinic's detailed guide on peritonitis.
Comparing Primary vs. Secondary Peritonitis
| Feature | Primary Peritonitis (SBP) | Secondary Peritonitis |
|---|---|---|
| Cause | Bacterial infection in existing ascites fluid, often from liver disease. | Infection spreading from a perforated abdominal organ or other injury. |
| Prevalence | Less common, but prevalent in patients with liver failure. | Most common form of peritonitis. |
| Origin of Infection | Spontaneous, without an identifiable external source. | Clear, identifiable source within the abdomen. |
| Surgical Need | Generally not required; managed with antibiotics. | Often requires emergency surgery to correct the perforation. |
| Diagnosis | Relies heavily on testing ascitic fluid. | Imaging often reveals the source of perforation. |
Potential Complications of Untreated Peritonitis
If left untreated, the consequences of peritonitis can be life-threatening and progress rapidly. The infection can spread from the peritoneum into the bloodstream, triggering a severe, full-body inflammatory response known as sepsis. Sepsis can lead to septic shock, multi-organ failure, and death. Other potential complications include:
- Dehydration due to significant fluid loss into the abdomen
- Intestinal paralysis, leading to constipation and blockage
- Development of internal abscesses
- Formation of scar tissue, potentially causing bowel obstruction later
- Recurrence of the infection
Conclusion: The Urgency of Peritonitis
In summary, when the peritoneum is inflamed, it signals a serious medical emergency, most often caused by a widespread infection inside the abdominal cavity. Recognizing the hallmark symptoms, particularly severe and worsening abdominal pain, is paramount. Given the rapid progression and potential for life-threatening complications like sepsis and organ failure, peritonitis demands immediate and aggressive medical intervention, including antibiotics and, frequently, emergency surgery. Waiting for symptoms to subside or trying home remedies is incredibly dangerous and can be fatal. If you or someone you know exhibits symptoms of peritonitis, seek emergency medical care without delay.
