Peritonitis

Peritonitis is inflammation of the peritoneum, which is a thin membrane that limits the inner abdominal wall and abdominal organs . This inflammation is generally caused by a bacterial or fungal infection. If not treated, the infection in peritonitis can spread throughout the body .

Normally, the peritoneum is clean of microorganisms. This layer serves to support the organs in the abdominal cavity and protect them from infection. However, in certain conditions or if there is a disease or problem in the digestive tract, the peritoneum can experience inflammation.

Based on the origin of the infection, peritonitis is divided into two, namely:

• Primary (spontaneous) peritonitis, which occurs as a result of bacterial or fungal infection directly in the peritoneum
• Secondary peritonitis, which occurs when bacteria or fungi from the organs of the digestive system enter the peritoneum due to a preexisting condition

Causes of Peritonitis

Primary peritonitis most often occurs due to cirrhosis of the liver accompanied by accumulation of fluid in the abdominal cavity ( ascites ). However, other conditions that can also cause ascites, such as heart failure or kidney failure, can also cause primary peritonitis.

In addition, the medical procedure of blood washing for kidney failure which is done by inserting fluid into the abdominal cavity ( CAPD ) is also a common cause of primary peritonitis.

Meanwhile, secondary peritonitis usually occurs due to a tear or hole in the digestive tract. The following are some conditions that can increase the risk of secondary peritonitis:

• Injury to the abdomen, for example as a result of a stab wound or gunshot wound
• Appendicitis , diverticulitis , or stomach ulcers that can rupture or tear
• Cancer in the digestive tract or organs, such as the liver and colon
• Inflammation of the pancreas ( pancreatitis )
• Pelvic inflammatory disease
• Inflammation of the digestive tract, such as Crohn's disease
• Infection of the gallbladder, small intestine, or bloodstream
• Surgery on the abdominal cavity
• Use of a feeding tube

Symptoms of Peritonitis

Symptoms generally experienced by peritonitis sufferers, among others:

• Abdominal pain that gets worse if you move or touch
• Bloated stomach
• Nausea and vomiting
• Fever
• Drown
• Decreased appetite
• Constantly feeling thirsty
• Diarrhea
• Constipation and can not pass gas
• The amount of urine that comes out is small
• Heart pounding

When should you go to the doctor?

Immediately check with a doctor if you experience the symptoms above, especially if your stomach feels unbearable and you have just suffered a stomach injury.

In patients with kidney failure undergoing dialysis through the stomach, inform the doctor if the fluid removed from the abdominal cavity shows the following signs:

• Dull colored
• Contains white flecks
• There are strands or lumps
• It smells bad, especially if the skin area around the catheter is red and painful

Diagnosis of Peritonitis

In diagnosing, the doctor will first ask about the patient's symptoms and health history. After that, the doctor will perform a physical examination by pressing on the patient's stomach, which may cause discomfort.

To strengthen the diagnosis while looking for the possible cause of peritonitis, the doctor will conduct supporting examinations, such as:

• Complete blood count examination , to see signs of infection and inflammation
• Blood culture, to find out if the bacteria has spread to the bloodstream
• Urine examination, to ensure there are no kidney problems
• An imaging test with an X-ray or CT scan of the stomach, to check if there are holes or tears in the digestive tract
• Analysis of peritoneal fluid samples ( paracentesis ), to see if there are signs of infection or inflammation
• Culture of peritoneal fluid, to find out the type of microorganisms that cause infection

In patients undergoing CAPD, doctors can confirm peritonitis by looking at the color of the fluid that comes out of the peritoneum.

Treatment of Peritonitis

Peritonitis is a serious condition that must be dealt with immediately, especially when the patient suffers from cirrhosis. Based on research, the percentage of death due to peritonitis in cirrhosis patients reaches 40%, while the percentage of death due to secondary peritonitis is in the range of 10%.

Patients with peritonitis should be hospitalized. Some treatment methods for patients are:

• Administration of antibiotics or antifungal drugs through infusion, to treat the infection and prevent the infection from spreading throughout the body
• A surgical procedure to remove infected tissue, close a tear in an internal organ, and prevent the spread of infection
• The administration of pain relievers, oxygen, or blood transfusions, depending on the symptoms experienced by the patient

In patients undergoing CAPD, the doctor will inject medicine directly into the peritoneal cavity, through a catheter that has been previously installed. Patients are also advised to stop CAPD activity and replace it with regular blood washing for a while, until the patient recovers from peritonitis.

Complications of Peritonitis

If not treated immediately, the infection in the peritoneum can spread to the bloodstream and cause damage to a number of body organs. Some complications that may arise due to peritonitis are:

• Hepatorenal syndrome, which is progressive kidney failure
• Sepsis , which is a severe reaction caused by bacteria that have entered the bloodstream
• Hepatic encephalopathy, which is the loss of brain function due to the liver not being able to filter toxins from the blood
• Abscess or collection of pus in the abdominal cavity
• Death of tissue in the intestine
• Intestinal adhesions that can cause intestinal blockage
• Septic shock , which is characterized by a drastic drop in blood pressure and is very dangerous

Prevention of Peritonitis

Prevention of peritonitis depends on the patient's condition. In patients suffering from cirrhosis and ascites, the doctor will prescribe antibiotics. While in patients undergoing CAPD, there are several ways that can be done to prevent peritonitis, namely:

• Wash your hands thoroughly before touching the catheter
• Clean the skin around the catheter with an antiseptic daily
• Store CAPD equipment in a hygienic place
• Wear a mask during the CAPD process
• Learn the technique of caring for a CAPD catheter from a nurse