The peritoneum is a thin layer surrounding the inner abdominal wall and the organs of the abdominal cavity. Inflammation of the peritoneum is known as peritonitis. It may arise with an infection, trauma or chemical injury within the abdominal cavity. The conditions that lead to peritonitis may occur in any age group but many of the causative factors are more likely to be seen in the senior years. Peritonitis is a very significant condition for patients undergoing peritoneal dialysis. It is important that they are aware of the condition, can immediately recognize symptoms and seek medical attention as soon as possible.
Signs and Symptoms
The onset of symptoms could be gradual or abrupt depending on the cause and degree of inflammation.
- Abdominal pain, fever, nausea or vomiting along with a rapid heart are the early symptoms of peritonitis.
- Abdominal distension may vary depending on the degree of irritation.
- Diarrhea or constipation may occur.
- There is low urine output and the patient may exhibit excessive thirst.
- Generalized fatigue is also seen.
- Unusual particles in dialysis fluid noticeable in patients undergoing peritoneal dialysis.
Overall the presentation of peritonitis may not be specific for the condition. Sometimes just a few symptoms may be present and the condition may be mistaken for some other abdominal ailment. The elderly generally do not present with specific symptoms in milder cases and the condition can sometimes remain undiagnosed for periods of time. However, the complications associated with peritonitis can be severe and only then alert the practitioner to the condition.
Acute peritonitis is usually infective in origin but also can be non-infective. Infection often arises from the naturally occurring bacteria escaping into the otherwise sterile abdominal cavity. Non-infective causes of peritonitis includes :
- Kidney failure
- Liver disease
- Abdominal surgery
- Abdominal trauma (blunt or sharp)
- Peritoneal dialysis
- Perforated peptic ulcers
- Cancer of an abdominal structure
Hospitalization is usually necessary especially with the elderly whose health status may deteriorate very quickly.
- Administration of intravenous fluids, blood transfusion and antibiotic administration is the usual line of treatment.
- Antibiotics and pain medication are the main drugs that are prescribed for peritonitis.
- In advanced peritonitis, repeated peritoneal lavage may be done.
- Surgical intervention may be necessary by removing the infected portion such as appendix and to prevent spread of infection.
- Oxygen supplementation and blood transfusion may be given.
- Recurrent peritonitis may be seen in patients undergoing peritoneal dialysis. These patients may be needed to be switched to other forms of dialysis to prevent recurrent attacks of peritonitis.
- Peritoneal abscess if present may need to be drained surgically.
The peritoneum has an extensive blood supply. With an infection, the microbes or its toxins can easily enter the bloodstream thereby leading to a host of complications. It is most severe with bacterial infections where in the worst case scenario it can be fatal. Therefore prompt treatment is required and elderly patients, who often have health complaints, should not be ignored when reporting non-specific abdominal symptoms.
Last Updated: August 13th, 2012 by Chris