Peritonitis: Causes, Symptoms And Treatment
Peritonitis is inflammation, usually caused by infection, of the peritoneum and the peritoneal cavity. Now, what is the peritoneum?
The peritoneum is a serous membrane that surrounds the abdominal viscera and the abdominal cavity. It has two layers, the space between them forming the peritoneal cavity. When this structure is colonized by pathogenic microorganisms, a serious condition occurs that requires rapid medical intervention.
Let’s see more about the peritoneum below to understand how peritonitis can affect you.
A little more about the anatomy of the peritoneum
Viscera that are completely covered by peritoneum are called intraperitoneal , while those that are only partially covered are retroperitoneal.
The limits of the peritoneum are as follows:
- Top: diaphragm.
- Lower: pelvic floor.
- Lateral: limits of the abdominal cavity.
This membrane has two layers, the parietal peritoneum, which lines the abdominal cavity; and the viscera l, which covers the viscera. A cavity is delimited between both layers, which is the peritoneal cavity.
It is interesting to know that this cavity is closed in men and open in women, through the fallopian tubes. In addition, it contains between 50 and 100 milliliters of a serous fluid called ascitic fluid.
The folds of the peritoneum are made up of mesos, ligaments and omentals, which divide the abdominal cavity into nine spaces and direct the exit of the different fluids from the cavity, so it can be predicted where possible infections will spread.
Types of peritonitis
Peritonitis can be divided based on different criteria:
- According to its location:
- Generalized.
- Located.
- According to its evolution:
- Sharp
- Chronicle.
- According to its etiology:
- Septic (produced by bacteria).
- Aseptic (irritation of the peritoneum without the presence of bacteria).
- According to its pathogenesis:
- Primary.
- High schools.
- Tertiary.
Let’s see below the types of peritonitis, according to its pathogenesis.
Primary peritonitis
Primary peritonitis is an infection of the ascites fluid with inflammation of the peritoneum in which there is no abdominal focus of infection. It is not very frequent, and it occurs more during the pediatric age.
Within this pathology, different pictures that we are going to develop can be differentiated.
1. Primary peritonitis in cirrhotic patients
Primary peritonitis in patients with cirrhosis is a condition that appears in up to 25% of patients with cirrhosis and its mortality is high. This is because liver cirrhosis alters the individual’s defenses, thus promoting bacterial proliferation.
The bacteria come from the intestinal lumen or from extra-intestinal infections, such as pneumonia or a urinary tract infection. The most common is that they are due to a single bacterial type, unlike secondary peritonitis where there is usually more than one type of microorganism.
The most frequent are Escherichia coli and bacteria of the genus Streptococcus.
It is diagnosed with an aspirate of the ascitic fluid for analysis. This fluid will have little protein and an increase in neutrophils (more than 250 per cubic millimeter), blood cells that are involved in defending against infection.
With a culture of the liquid you can know the microorganism that produces them. It is a condition that requires rapid antibiotic treatment.
Other causes of primary peritonitis are infections such as tuberculosis, some autoimmune processes, and peritoneal dialysis.
2. Primary peritonitis due to peritoneal dialysis
Peritoneal dialysis is a therapeutic procedure to clean the peritoneal cavity. It consists of introducing sterile fluid into the peritoneal cavity with a catheter.
After a few hours this liquid is eliminated, dragging the waste products that were in this cavity. In some cases the cavity can become contaminated and a picture of peritonitis appears.
It is diagnosed because the patient will be feverish and with abdominal pain shortly after the procedure. In addition, the ascitic fluid acquires a cloudy color with an increase in leukocytes, blood cells that are part of the immune system.
In this case a culture will be useful to clarify the diagnosis. And with regard to treatment, in this picture it is necessary to introduce antibiotics with the dialysate, reviewing the catheter and if necessary, withdrawing it.