Peritonitis - spontaneous

Definition

Peritonitis is the inflammation of the peritoneum, which is the membrane that lines the abdominal wall and covers the abdominal organs. Spontaneous peritonitis is an infection that occurs as a complication of ascites (a collection of fluid in the peritoneal cavity), which is usually related to liver or kidney failure.

Causes, incidence, and risk factors

Most cases of bacterial peritonitis occur:

• When fluid accumulates in the peritoneal cavity (ascites) because of chronic liver disease.
• In renal (kidney) failure patients undergoing peritoneal dialysis. In these patients, the cause of spontaneous peritonitis is infection that spreads to the peritoneal fluid, usually from a contaminated peritoneal dialysis catheter.

Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis (Hepatitis B or C).

Symptoms

• Fluid in the abdomen
• Abdominal pain and distention
• Abdominal Tenderness
• Fever
• Low urine output

• Nausea and vomiting
• Joint pain
• Chills

Signs and tests

Tests that show infection:

• Culture of peritoneal fluid
• Chemical examination of peritoneal fluid
• Peritoneal fluid analysis( paracentesis)
• Cytologic examination (cell studies) of peritoneal fluid
• Blood culture

• Abdominal imaging studies (to rule out other causes of abdominal pain)
• WBC (nuclear) scan

Treatment

Treatment depends on the cause of the peritonitis. Surgery may be needed in cases where peritonitis is asociated with a foreign object, such as a peritoneal dialysis catheter. Antibiotics are administered to control infection in cases of spontaneous peritonitis in patients with liver or kidney disease, and dehydration is treated by intravenous therapy.

Hospitalization is common and may be necessary to rule out other causes of peritonitis such as appendicitis and diverticulitis.

Expectations (prognosis)

The infection can usually be treated, but the extent of recovery is limited by the patient's underlying kidney or liver disease.

Complications

• Abscess development
• Intestinal obstruction from scar tissue
• Hepatorenal syndrome
• Hepatic encephalopathy
• sepsis

Calling your health care provider

Call your health care provider if you have symptoms of peritonitis; this can quickly become an emergency situation!

Prevention

In patients with peritoneal catheters, sterile techniques should be closely followed. In cases of liver failure, antibiotics may be used to prevent recurrences of peritonitis.

Illustrations

Peritoneal sample

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Spontaneous bacterial peritonitis (SBP)