Peritonitis - spontaneous

Definition

Peritonitis is inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

Alternative Names

Spontaneous bacterial peritonitis (SBP)

Causes, incidence, and risk factors

Spontaneous peritonitis is usually caused by infection of ascites, a collection of fluid in the peritoneal cavity. This usually occurs from liver or kidney failure.

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

Spontaneous peritonitis also occurs in patients who are on dialysis for kidney failure.

Symptoms

• Abdominal pain and bloating
• Abdominal tenderness
• Fever
• Low urine output

Other symptoms include:

• Chills
• Joint pain
• Nausea and vomiting

Signs and tests

Tests will be done to check for infection and rule out other causes of abdominal pain:

• Blood culture
• White blood cell count in a sample of peritoneal fluid
• Chemical examination of peritoneal fluid
• Culture of peritoneal fluid
• CT scan or ultrasound of the abdomen

Treatment

Treatment depends on the cause of the peritonitis.

• Surgery may be needed if peritonitis is caused by a foreign object, such as a catheter used in peritoneal dialysis.
• Antibiotics may control infection in cases of spontaneous peritonitis with liver or kidney disease.
• Intravenous therapy can treat dehydration.

You may need to stay in the hospital so health care providers can rule out other causes of peritonitis, such as appendicitis and diverticulitis.

Support Groups

Expectations (prognosis)

The infection can usually be treated. However, kidney or liver disease may limit recovery.

Complications

• Hepatic encephalopathy
• Hepatorenal syndrome
• 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

Patients with peritoneal catheters should be treated with sterile techniques. In cases of liver failure, antibiotics may help prevent peritonitis from coming back.

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References

Garcia-Tiso G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 157.

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 145.