What is this Condition?

Peritonitis is an acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the abdominal organs. The inflammation may extend throughout the peritoneum or may create an abscess in one spot.

Peritonitis commonly decreases the intestine’s action and causes it to bulge with gas. The death rate is 10%. Mortality was much higher before the advent of antibiotics.

What Causes it?

In peritonitis, bacteria invade the peritoneal membrane. The bacteria typically come from the digestive tract during traumatic disorders such as appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, strangulated bowel obstruction, an abdominal tumor, or a stab wound. Peritonitis can also be a chemical inflammation. This can follow rupture of a fallopian tube, ovarian tube, or the bladder. Other possible causes include perforation of a gastric ulcer or release of pancreatic enzymes. In both types of inflammation, accumulated fluids containing proteins and electrolytes make the normally transparent peritoneum red, inflamed, and swollen.

What are its Symptoms?

The person with peritonitis feels sudden, severe, and widespread abdominal pain that tends to intensify and localize in the area of the underlying infection. For instance, if appendicitis causes the rupture, pain focuses in the lower right abdomen.

The person is often weak, pale, sweating, and has cold skin due to excessive loss of fluid, electrolytes, and protein into the abdominal cavity. Intestinal muscles stop working and the resulting obstruction causes nausea, vomiting, and abdominal rigidity.

Other symptoms include light-headedness, irregular heartbeat, signs of dehydration (thirst, dry swollen tongue, pinched skin), acutely tender abdomen, and a fever. Inflammation of the peritoneum around the diaphragm may cause shoulder pain and hiccups. Abdominal pressure can interfere with breathing. Typically, the person with peritonitis tends to breathe shallowly and move as little as possible to minimize pain.

How is it Diagnosed?

Severe abdominal pain in a person with tenderness suggests peritonitis. The doctor will use abdominal X-rays to confirm that the small and large bowels are distended. If the person has perforation of a visceral organ, the X-ray shows air in the abdominal cavity. Other tests that may provide information include chest X-ray, blood studies, paracentesis, and laparotomy.

How is it Treated?

The doctor will try to treat any digestive tract inflammations early enough to prevent peritonitis. After peritonitis develops, however, the doctor will take emergency measures to combat infection, restore intestinal activity, and replace fluids and electrolytes.

Massive antibiotic therapy usually includes administration of Mefoxin with an aminoglycoside or Bicillin L-A and Cleocin with an aminoglycoside, depending on the infecting organisms. To decrease muscle movement and prevent perforation, the person should receive nothing by mouth, but should receive supportive fluids and electrolytes intravenously.

Surgical Treatment

When peritonitis is caused by perforation, surgery is necessary as soon as the persons condition is stable enough to tolerate it. To prepare the person for surgery, the doctor will give pain relievers and use a nasal tube to relieve pressure in the bowel and, possibly, a rectal tube to help the person pass gas.

The surgeon’s job is to eliminate the source of infection by evacuating the spilled contents and inserting drains. Occasionally, a tube is used to remove accumulated fluid. Irrigation of the abdominal cavity with antibiotic solutions during surgery may be appropriate in some cases.

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Grouped under this heading are a number of diseases in which nerve cells degenerate and die, usually quite slowly, taking months or years. The symptoms of the various diseases differ widely, depending on the area of the brain or spinal cord in which the degeneration of the nerve cells occurs. The results are distressing and sometimes even tragic. But there is hope because scientific research into causes and possible treatments is gradually increasing our understanding of these disorders. With this new understanding it is reasonable to hope for more and increasingly effective treatments.