PERITONITIS

Peritonitis is a bacterial or fungal infection of the peritoneum, a silk-like membrane that

lines your inner abdominal wall and covers the organs within your abdomen. The
infection can be a complication of peritoneal dialysis. It can also be caused by peritoneal
fluid buildup, another infection, inflammation or an injury.

Whatever the cause, peritonitis requires prompt medical attention to fight the infection
and, if necessary, to treat any underlying medical conditions. Treatment of peritonitis
usually involves antibiotics and, in some cases, surgery. Left untreated, peritonitis can
lead to severe, potentially life-threatening infection throughout your body.

SIGNS AND SYMPTOMS OF PERITONITIS INCLUDE:

• Abdominal pain or tenderness

• Bloating or a feeling of fullness (distention) in your abdomen
• Fever
• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Low urine output
• Thirst
• Inability to pass stool or gas
• Fatigue

CAUSES:

Infection of the peritoneum can happen for a variety of reasons. Here are the most
common causes of peritonitis:

• Peritoneal dialysis. Dialysis removes waste products and extra fluid from your
blood when your kidneys can no longer adequately do so. With peritoneal
dialysis, the network of tiny blood vessels in your abdomen (peritoneal cavity) is
used to filter your blood. Peritonitis is the most common complication associated
with peritoneal dialysis. An infection may occur during peritoneal dialysis due to
unclean surroundings, poor hygiene or contaminated equipment.
• Fluid buildup. Diseases that cause liver damage, such as cirrhosis, can result in a
large amount of fluid buildup in your abdominal cavity (ascites). That fluid
buildup is susceptible to bacterial infection. This type of peritonitis is called
spontaneous peritonitis.

Secondary peritonitis
When other medical conditions result in an infection that causes peritonitis, it's referred
to as secondary peritonitis. These causes include:
 • A ruptured appendix, stomach ulcer or perforated colon. Any of these
conditions can allow bacteria to get into the peritoneum through a hole in your
gastrointestinal tract.
• Pancreatitis. Inflammation of your pancreas (pancreatitis) complicated by
infection may lead to peritonitis if the bacteria spread outside the pancreas.
• Diverticulitis. Infection of small, bulging pouches in your digestive tract
(diverticulitis) may cause peritonitis if one of the pouches ruptures, spilling
intestinal waste into your abdomen.
• Trauma. Injury or trauma may cause peritonitis by allowing bacteria or
chemicals from other parts of your body to enter the peritoneum.

COMPLICATONS

Left untreated, peritonitis can extend beyond your peritoneum, where it may cause:

• A bloodstream infection (bacteremia).

• An infection throughout your body (sepsis). Sepsis is a rapidly progressing, life-
threatening condition that can cause shock and organ failure.

DIAGNOSTIC PROCEDURES

• Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of
the fluid in your peritoneum (paracentesis). If you have peritonitis, examination of
this fluid may show an increased white blood cell count, which typically indicates
an infection or inflammation. A culture of the fluid may also reveal the presence
of bacteria.
• Blood tests. A sample of your blood may be drawn and sent to a lab to check for
a high white blood cell count. A blood culture also may be performed to
determine if there are bacteria in your blood.
• Imaging tests. Your doctor may want to use an X-ray to check for holes or other
perforations in your gastrointestinal tract. Ultrasound may also be used. In some
cases, your doctor may use a computerized tomography (CT) scan instead of an
X-ray.

The above tests may also be necessary if you're receiving peritoneal dialysis and a
diagnosis of peritonitis is uncertain after a physical exam and examination of the dialysis
fluid.

THERAPUTIC MANAGEMENT

To treat peritonitis, your doctor will likely prescribe an antibiotic medication to fight the
infection and prevent it from spreading. The type and duration of your antibiotic therapy
depend on the severity of your condition and the kind of peritonitis you have.
You may need to be hospitalized for peritonitis that's caused by infection from other
medical conditions (secondary peritonitis). Surgery is often necessary to remove infected
tissue, treat the underlying cause of the infection and prevent the infection from
spreading.

If you're undergoing peritoneal dialysis and you have peritonitis, your doctor may
recommend that you receive dialysis in another way for several days while your body
heals from the infection. If peritonitis persists or recurs, you may need to stop having
peritoneal dialysis entirely and switch to a different form of dialysis.

PREVENTION

Often, peritonitis associated with peritoneal dialysis is caused by germs around the
catheter. If you're receiving peritoneal dialysis, take the following steps to prevent
peritonitis:

• Wash your hands, including underneath your fingernails and between your
fingers, before touching the catheter
• Clean the skin around the catheter with antiseptic every day
• Store your supplies in a sanitary area

If you've had spontaneous peritonitis before, or if you have peritoneal fluid buildup due
to a medical condition such as cirrhosis, your doctor may prescribe antibiotics to prevent
peritonitis.

NURSING RESPONSIBILITIES

Assess nature of pain, location in the abdomen, and shifts of pain and location.
• Assess vital signs, gastrointestinal function, fluid and electrolyte balance.
• Administer analgesic medication and position for comfort (e.g. on side with knees
flexed to decrease tension on abdominal organs).
• Record intake and output and central venous pressure.
• Administer and monitor intravenous fluids closely.
• Observe and record character of any surgical drainage.
• Observe for decrease in temperature and pulse rate, softening of the abdomen, return of
peristaltic sounds, and passage of flatus and bowel movements, which indicate peritonitis
is subsiding.
• Increase food and oral fluids gradually, and decrease parenteral fluid fluid intake when
peritonitis subsides.
• Observe and record character of drainage from postoperative wound drains if inserted;
take care to avoid dislodging drains.
• Postoperatively, prepare patient and family for discharge; teach care of of incision and
drains if still in place at discharge.
 PATHOPYSIOLOGY

Contamination of peritoneal cavity

Chronic inflammation

Abscess formation Fluid shift to peritoneal state

Sepsis and shock Decrease in peristalsis in bowel

Hypovolemia

Shock and electrolyte imbalance