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Peritonitis

Acute abdomen; Spontaneous bacterial peritonitis; SBP; Cirrhosis - spontaneous peritonitis

Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

Causes

Peritonitis is caused by a collection of blood, body fluids, or pus in the belly ( abdomen ).

Abdomen

An abdominal abscess is a pocket of infected fluid and pus located inside the belly (abdominal cavity). This type of abscess can be located near or ...

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One type is called spontaneous bacterial peritonitis (SPP). It occurs in people with ascites. Ascites is the buildup of fluid in the space between the lining of the abdomen and the organs. This problem is found in people with long-term liver damage, certain cancers, and heart failure.

Peritonitis may be a result of other problems. These include:

Trauma or wounds to the belly
Ruptured appendix
Ruptured diverticula

Ruptured diverticula

Diverticula are small, bulging sacs or pouches that form on the inner wall of the intestine. Diverticulitis occurs when these pouches become inflame...

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Infection after any surgery in the belly

Symptoms

The belly is very painful or tender. The pain may become worse when the belly is touched or when you move.

Your belly may look or feel bloated. This is called abdominal distention .

Abdominal distention

Abdominal bloating is a condition in which the belly (abdomen) feels full and tight. Your belly may look swollen (distended).

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Other symptoms may include:

Fever and chills

Fever

Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...

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Passing little or no stools or gas
Excessive fatigue
Passing less urine

Passing less urine

Decreased urine output means that you produce less urine than normal. Most adults make at least 500 ml of urine in 24 hours (a little over 2 cups)....

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Nausea and vomiting

Nausea and vomiting

Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...

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Racing heartbeat
Shortness of breath

Exams and Tests

The health care provider will perform a physical exam. The abdomen is usually tender. It may feel firm or "board-like." People with peritonitis usually curl up or refuse to let anyone touch the area.

Blood tests, x-rays, and CT scans may be done. If there is a lot of fluid in the belly area, the provider may use a needle to remove some and send it for testing.

Treatment

The cause must be identified and treated right away. Treatment typically involves surgery and antibiotics.

Possible Complications

Peritonitis can be life threatening and may cause complications. These depend on the type of peritonitis.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of peritonitis.

Open References

References

Kuemmerle JF. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 142.

Levinson ME, Bush LM. Peritonitis and intraperitoneal abscesses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 76.

Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline: management of adult patients with ascites due to cirrhosis 2012. Hepatology . 2013;57(4):1651-1653. PMID: 23463403 www.ncbi.nlm.nih.gov/pubmed/23463403 .

Peritoneal sample - illustration

The peritoneum is the membrane lining the abdominal cavity.

Peritoneal sample

illustration
Abdominal organs - illustration

The stomach and intestines are the main organs of digestion, coverting and breaking down food into substances which are either absorbed by or excreted from the body.

Abdominal organs

illustration
Gastroschisis repair - series

Presentation

<strong>Normal anatomy</strong><p>In the womb, fetal intestines develop outside of the abdomen for a brief time. Normally, the intestines return to the abdominal cavity and the abdomen is closed at birth. </p>

<strong>Indications</strong><p>Gastroschisis is an abdominal wall defect to the side of the umbilical cord (umbilicus). The infant is born with intestines protruding through the defect and no protective sac is present. Gastroschisis is rarely associated with other birth defects. Gastroschisis is a life-threatening event requiring immediate intervention. </p>

<strong>Procedure</strong><p>Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen. Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A tube is inserted into the stomach (nasogastric tube, also called NG tube) to keep the stomach empty and to prevent choking on or breathing in of stomach contents into the lungs. While the infant is deep asleep and pain-free (under general anesthesia) an incision is made to enlarge the hole in the abdominal wall. The intestines are examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges stitched together. A tube is inserted into the stomach and out through the skin. The organs are replaced into the abdominal cavity and the incision closed, if possible. If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch will be made from a sheet of plastic to cover and protect the organs. Complete closure may be done over a few weeks. Surgery may be necessary to repair the abdominal muscles at a later time. The infant's abdomen may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties. The infant may require the use of a breathing tube and machine (ventilator) for a few days or weeks until the swelling of the abdominal organs has decreased and the size of the abdomen has increased. </p>

<strong>Aftercare</strong><p>The defect can be corrected with surgery in most cases. The outcome depends on the amount of damage to or loss of intestine. The infant is cared for post-operatively in a neonatal intensive care unit. The baby is placed in an isolette (incubator) to keep warm and prevent infection. The baby will be given oxygen and often require mechanical ventilation. Intravenous fluids and antibiotics and pain medication will be given. A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement. </p>

Peritoneal sample - illustration

The peritoneum is the membrane lining the abdominal cavity.

Peritoneal sample

illustration
Abdominal organs - illustration

The stomach and intestines are the main organs of digestion, coverting and breaking down food into substances which are either absorbed by or excreted from the body.

Abdominal organs

illustration
Gastroschisis repair - series

Presentation

Self Care

Tests for Peritonitis

Review Date: 2/27/2016

Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Multimedia Encyclopedia

Peritonitis

Causes

Abdomen

Ruptured diverticula

Symptoms

Abdominal distention

Fever

Passing less urine

Nausea and vomiting

Exams and Tests

Treatment

Possible Complications

When to Contact a Medical Professional

References

Peritoneal sample - illustration

Peritoneal sample

Abdominal organs - illustration

Abdominal organs

Gastroschisis repair - series