Peritonitis, peritonitis or peritonitis is a painful inflammation of the peritoneum. The condition can be fatal if left untreated and should be examined and treated by a doctor as soon as possible if suspected. Typical symptoms and signs of peritonitis include severe pain in the upper abdomen on movement and tightening of the abdominal wall.
What is peritonitis?
Peritonitis is referred to in medical circles as peritonitis. The peritoneum is the abdominal lining, which may not always be completely affected by inflammatory processes. In addition to a localized inflammation that affects only certain organ areas, the so-called generalized or diffuse peritonitis is characterized by a deviating course of the disease. The suffix -itis denotes the aspect that it is an inflammatory process. Divergent courses are observed in peritonitis.
Causes
Various influencing factors can be considered as the cause of peritonitis. The inflammatory processes of the peritoneum may result from the invasion of disease-causing bacteria from the outside. These can, for example, be carried into the abdominal wall by the unintentional influx of examination media such as X-ray contrast substances or intestinal contents. Peritonitis is often a secondary condition of other causative diseases in the abdomen. In this context, accumulations of bacteria from foci of pus and inflammation from adjacent organs can enter the peritoneum. Typical triggers are, for example, acute appendicitis or when a gastric ulcer has passed through the wall of the stomach. In more rare cases, peritonitis can result from injury to adjacent hollow organs during medical examinations, causing their contents to spill onto the peritoneum. Surprisingly, pathogens that are transported through the blood and lymphatic systems can also settle on the peritoneum and cause peritonitis there. Depending on which causes are considered for the development of peritonitis, a distinction is made between primary and secondary peritonitis.
Symptoms, complaints, and signs
In peritonitis, there is severe abdominal pain, and fever often occurs. The abdominal wall is very tense and sensitive to pressure, and the affected person tries to adopt a protective posture to relieve the severe pain. There are two types of peritonitis that can have different symptoms: localized peritonitis and diffuse peritonitis. In localized peritonitis, the abdominal pain occurs in the area of the abdomen that is causing the inflammation. A defensive tension is felt in this area. For example, in appendicitis, the pain is usually confined to the lower right abdomen. The pain may be accompanied by nausea, constipation, and fever. In diffuse peritonitis, the abdominal pain occurs throughout the abdomen and the abdominal wall is hard, with the affected person doubled over in pain. There are disturbances in gastrointestinal activity. Because the whole abdomen is affected, the symptoms of diffuse peritonitis are more dramatic. Symptoms of septic shock may occur, such as low blood pressure with an accelerated heartbeat, problems with breathing, high fever, and cold sweats. Because the signs are not always obvious, urgent medical evaluation is needed because diffuse peritonitis is life-threatening if not treated promptly.
Course
The course of the disease is characterized by more or less specific and general signs of inflammation in the respective types of peritonitis. Those affected initially complain of the typical symptoms of illness associated with an infection. They feel dull and listless, suffer from loss of appetite and a reduced general condition. Typical progressions of peritonitis are the painful complaints in the upper abdominal region that occur during the stages. On manual palpation, the abdomen feels hardened and shows severe tension. Immense pain occurs even when the abdominal wall is pressed lightly. Patients usually show nausea and vomiting as the disease progresses.A decrease in body temperature in the extremities and a pale face are also clear. Due to the pain, breathing is difficult and sluggish, so that the heartbeat is increased. In many cases, fever occurs with peritonitis.
Complications
Peritonitis is already a serious illness and in any case requires rapid evaluation by a physician. In the case of severe inflammation of the peritoneum, serious complications can occur despite treatment of the cause, such as respiratory arrest as a result of sepsis or kidney failure. In the course of the disease, it can also lead to wound healing disorders and subsequently to intestinal obstruction and severe adhesions and adhesions in the gastrointestinal tract and abdominal cavity. The complications are exacerbated by the triggering disease, which in peritonitis is usually a ruptured appendix or intestinal obstruction. If peritonitis is treated surgically, bleeding, chronic pain, and allergic reactions may occur. Rarely, an incisional hernia also occurs, through which stool, digestive juices and pus can enter the abdominal cavity. This is often associated with further inflammation and other life-threatening complications. Common sequelae of peritonitis are abscesses, sepsis or intestinal paralysis, which lead to death in up to 30 percent of those affected. If the inflammation is well survived, however, the risk of further complications rapidly decreases. Gastrointestinal discomfort and abdominal pain related to movement may also occur for a long time after treatment.
When should you see a doctor?
The first signs of peritonitis are quite nonspecific. Typically, the condition is accompanied by pain in the upper abdomen, fever, nausea, facial pallor, loss of appetite, and general weakness. It is important to seek medical advice quite promptly, as some of the courses can be severe to life-threatening, depending on the cause of the peritonitis. Therefore, clarification as early as possible with identification of the causes can be life-saving. Peritonitis can be caused, for example, by an acute appendicitis, by a gastric ulcer, by carryover of bacteria from inflammatory sites into the abdominal cavity, or by intestinal contents that may enter the abdominal cavity after injury to the small intestine. For a promising therapy, it is enormously important to combat or eliminate the causative disease or injury. The earliest possible, goal-oriented therapy requires that ill persons suffering from the symptoms described above go to the doctor without delay. Competent contacts can be experienced general practitioners or internists who can carry out initial clarifications via the medical history and via an ultrasound examination and can advise or decide on the further diagnostic and therapeutic steps. Waiting for days can lead to significant complications such as renal failure or blood poisoning (sepsis) and other life-threatening conditions.
Treatment and therapy
In general, peritonitis is a disease that should not be underestimated, as it can lead to life-threatening limitations if left untreated. If the disease is detected in time by the affected person going to the doctor, various therapies can be helpful. However, it must be weighed up here whether it is an acute occurrence in which only the emergency physician can provide therapy, because in many cases peritonitis can be fatal. The forms of therapy are intensive, because there are the possibilities of surgical intervention and a therapy with intensive medical means. Acute peritonitis is always treated surgically. As a subsequent therapy, in the case of a very severe clinical picture with the signs of bacterial poisoning, intensive medical care may be unavoidable due to the possibly foreseeable risks. Within the medical treatment, drugs such as high doses of analgesics and a so-called post and secondary ventilation are extremely useful. Antibiotics are also used to treat peritonitis.
Aftercare
Because peritonitis often rapidly develops into a medical emergency, follow-up care is usually included in treatment. Immediate emergency call is essential.Acute but as yet undetected causative agents in the abdominal cavity are responsible for the classic symptoms of peritonitis. These must be treated immediately because of the danger to life. In addition, peritonitis can cause later organ damage. Without surgery, peritonitis cannot be improved in most cases. In addition, appropriate measures and quick action must be taken to prevent sepsis from occurring postoperatively. The subsequent treatment with antibiotics already represents a part of the necessary aftercare. The healing process of the surgical wound and the underlying triggers must also be monitored. In rare cases, inflammation of the peritoneum forms even without an identifiable trigger. In this case, a careful differential diagnosis must rule out a trigger that requires surgery. Subsequently, the affected person is cured with antibiotic therapy during follow-up care. The earlier treatment is given, the sooner the patient can recover from the life-threatening emergency.
Outlook and prognosis
The prognosis for peritonitis depends on the severity of the condition, the type of medical care provided, and the age of the patient. There is a good chance of recovery if the disease can be detected early and treated as an inpatient. There is also a good chance of freedom from symptoms if the inflammation was acquired as a consequence of the removal of the appendix. If the patient has a strong immune system and leads a healthy lifestyle, his chances of a quick recovery increase. If there are no other chronic diseases or signs of inflammation, the patient is usually free of symptoms again within a few weeks. The younger and healthier a patient is, the better the prognosis for peritonitis. In addition, the chances of recovery from the serious illness increase if the patient is treated in hospital. The possibilities of outpatient medical care are not sufficient to bring about the fastest possible recovery. A prognosis for organ rupture is less optimistic. If the inflammation spreads throughout the abdominal cavity due to the organ rupture, the body often does not have the resources necessary for healing. The organism cannot mobilize sufficient self-healing forces despite very good medical care.
This is what you can do yourself
Peritonitis is usually a medical emergency that requires surgical treatment. Complementary, the symptoms and discomfort can be relieved by a number of self-measures and home remedies. After the surgical procedure, bed rest and sparing apply. In most cases, a radical change in diet is also necessary to avoid diarrhea and abdominal pain. After four to six weeks, the abdomen should have calmed down and the usual diet is possible again. To speed up recovery, some remedies from nature can be resorted to. Effective medicinal plants include arnica, witch hazel, chamomile and juniper. Administered in the form of teas or hot baths, these plants have an anti-inflammatory and analgesic effect. A decoction of burnet, holly, cowslip and agrimony has a similar effect. Localized peritonitis can rarely also be treated by a zero diet and bed rest. However, a prerequisite for self-treatment is that the triggering disorder has been diagnosed and is responding to similar treatment measures. In general, possible triggers should be identified and recorded for later medical attention. By doing so and avoiding irritating foods, complication-free treatment of peritonitis is possible.