| Peritonitis is an acute or chronic inflammation of the membrane (peritoneum) that lines the wall of the abdomen and covers the abdominal organs.
Peritonitis is caused by an invasion of bacteria or foreign matter following rupture of an internal organ, an infection in the bloodstream, an infection originating elsewhere in the body, a penetrating injury to the abdominal wall, or an accidental contamination during surgery.
There are three types of peritonitis: spontaneous peritonitis, secondary peritonitis, and dialysis-associated peritonitis. Risk factors for spontaneous peritonitis include liver disease (cirrhosis) caused by alcoholism or other liver conditions, a group of kidney diseases (nephrotic syndrome), ulcer disease, appendicitis, and diverticulitis. Risk factors for secondary peritonitis include a perforation in the gastrointestinal tract (e.g., perforated bowel or ruptured appendix), and severe chemical reactions from bile or pancreatic enzymes as a result of injury to, or perforation of, the intestine or biliary tract. Dialysis-associated peritonitis occurs when bacteria (most commonly pneumococci and staphylococci) are introduced into the peritoneum by the dialysis procedure. |
Source: Medical Disability Advisor
| History: The individual will present with complaints of abdominal pain, abdominal distension, fever, and excessive thirst. The individual may also complain of low urine output and an inability to pass gas or feces. Many individuals will complain of a specific area of tenderness that they are able to touch or point out (point tenderness). Additional symptoms include nausea and vomiting, joint pain, and chills. Physical exam: Physical examination will reveal abdominal pain to the touch (upon palpation), rebound tenderness, abdominal rigidity, increased heart rate (tachycardia), low blood pressure (hypotension), fever, decreased bowel sounds, an accumulation of fluid in the abdomen (ascites), and decreased respirations. Those with dialysis-associated peritonitis will have cloudy dialysis fluid. Tests: Laboratory tests will include complete blood count (CBC) with differential; blood culture; peritoneal fluid culture, chemical analysis, and cell studies (cytology); urinalysis; and urine culture. Other diagnostic procedures may include chest and abdominal x-rays, and an ultrasound or CT scan of the abdomen and pelvis. Sometimes a surgical procedure called an exploratory laparotomy may be performed. |
Source: Medical Disability Advisor
| The individual is usually hospitalized for treatment. Treatment depends on the underlying cause of the peritonitis. Surgery is sometimes necessary to remove an infected bowel, abscess, inflamed appendix, or other source of infection; or to repair sources of infection, such as a perforated ulcer. Either intravenous or intraperitoneal antibiotics will be given to control infection. Intravenous fluids will be given to control dehydration. A nasogastric (NG) tube will be placed to decompress the stomach, and narcotics and sedatives will be given to keep the individual comfortable and calm. |
Source: Medical Disability Advisor
| For dialysis-associated peritonitis, most individuals recover uneventfully with either intraperitoneal or intravenous antibiotics.
For spontaneous and secondary peritonitis, regardless of treatment modality, the outcome depends on the underlying cause of the disease and the duration of symptoms before treatment was begun. Complete recovery can occur, but in some cases the disease can be lethal. Individuals with spontaneous peritonitis due to cirrhosis have a 3-year mortality rate of 50% (Shah). Severe sepsis occurs in 11% of all individuals with peritonitis, and of these cases, 63% are fatal (Anaya). |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| If the individual underwent surgery, heavy lifting should be avoided for a minimum of 6 weeks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual complain of abdominal pain, abdominal distension, or excessive thirst?
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Does individual have a medical history (i.e., peptic ulcer disease, recent gastrointestinal surgery, cirrhosis, or peritoneal dialysis, etc.) that may place him/her at increased risk for developing peritonitis?
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Was abdomen rigid? Was there abdominal guarding?
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Was a peritoneal tap done? Was a peritoneal culture positive?
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Did an ultrasound or CT of the abdomen demonstrate findings consistent with the diagnosis of peritonitis? Were blood cultures positive?
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If culture of dialysis fluid was appropriate, were results positive?
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If the diagnosis was uncertain, were other possible conditions ruled out (e.g., constipation/fecal impaction, appendicitis, perforated ulcer)?
Regarding treatment:
- Was individual given intravenous or intraperitoneal antibiotics?
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Did individual require surgery? If so, what did the surgical exploration reveal?
Regarding prognosis:
- What was the expected outcome?
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Did individual have any complications, such as abscess formation, adhesions, sepsis, or multisystem organ failure that would impact recovery?
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Does individual have any underlying conditions that could impact ability to recover (e.g., cirrhosis, malnutrition, or immune suppression)?
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Source: Medical Disability Advisor
| Anaya, D. A., and A. B. Nathens. "Risk Factors for Severe Sepsis in Secondary Peritonitis." Surgical Infections 4 4 (2003): 355-362.Shah, Rahil, and Janice M. Spears. "Ascites." eMedicine. Eds. Robert J. Fingerote, et al. 22 Nov. 2004. Medscape. 19 Dec. 2004 <http//emedicine.com/med/topic173.htm>. |
Source: Medical Disability Advisor
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