There are several factors which can contribute at increasing the risk of peritonitis.
For example, risk factors for primary peritonitis are: cirrhosis (liver disease), kidney damage, pelvic inflammation, fluid in the abdomen, a deficitary immune system.
The following items represent a risk factors for secondary peritonitis: stomach ulcers, damaged intestine or pancreas, appendicitis, inflammatory bowel disease.
The causes of peritonitis are multiple and they differ depending on the disease’s type.
Spontaneus peritonitis (primary peritonitis) usually appears on patients who suffer from liver,kidney or heart disease. A certain quantity of fluid accumulates in the abdominal cavity allowing the development of infectious microorganisms. This process it’s also known as ascites. Usualy a person has a small quantity of fluid in the stomach. When this quantity grows because of a certain disease the fluid can get infected resulting in peritonitis.
Another type of peritonitis is spontaneous bacterial peritonitis which occurs in the absence of a known source of contamination .
The main cause of secondary peritonitis is the spillage of bacteria, bile or enzymes into the peritoneum from a hole of the billiary or gastrointestinal tract.This hole can be caused by an infected organ or by the perforation of the stomach,of the distal oesophagus or of the intestine.Usually the peritoneum is transparent. A peritoneum infected with bacteria or fluids containing protein and electrolytes becomes red, opaque, inflamed.
Other causes of secondary peritonitis are:
* An untreated ulcer causes the perforation of the stomach’s wall and allows the leak of food and digestive juice into the abdomen.
* Another cause of peritonitis is a perforated bowel which occurs when the intestines are damaged by inflammatory diseases like Crohn’s disease.
* The bile from the liver is stored into a small sac called the gall bladder. An infection can cause the perforation of the gall bladder. Also the inflammation of gall bladder, known as cholecystitis is a cause of peritonitis.
* The large intestine has a thin “tail” called the appendix. Food or excrements can be deposited into the appendix so the burst of the appendix can be also a source of infection.
* The inflammation of the fallopian tube.
* Pancreatitis (the inflammation of the pancreas) caused by alcoholism and gallstones which produces the inflammation of the abdomen.
* There are cases when the fertilised egg deposits in the fallopian tube. This is called ectopic pregnancy. The rupture of this tube represents also a cause of peritonitis.
* The bleeding in the abdominal cavity causes the irritation of the peritoneum resulting in peritonitis .
* The disruption of the peritoneum may also result in an ainfection because micro-organisms get into the peritoneal cavity.
* Sistemic infections, like tuberculosis, represent a cause for peritonitis, although is rarely seen.
* A cause of peritonitis can be a disease called familial Mediterranean fever.
* People with cancer (especially from the ovaries, uterus, breasts, pancreas, colon, stomach) are predisposed to peritonitis.
* At sexually active women an infection of the uterus or of the fallopian tubes causes the disease called pelvic inflammatory which can lead to peritonitis.
Peritonitis can be caused by any type of infection. For example during an abdominal surgery the ureter,the bladder or the intestine can be injured allowing bacteria to spill into the abdomen.
At a dialysis bacteria on the equipment for peritoneal dialysis can rich into the abdominal cavity. A stab wound it’s also cause of peritonitis because bacteria from a knife can rich into the abdomen.
Sometimes peritonitis can be caused by the leakage of steril fluids into the peritoneum like blood, pancreatic or gastric juice, urine,menstruum. This is a non-infected cause because these fluids are steril, they become infected after they leave their organ leading to peritonitis in 1-2 days.
The irritation of the abdominal organs is also a non-infected cause of peritonitis as well as the inflammation of the peritoneum caused by the talc from the surgeon’s gloves.
The treatment for peritonitis is strictly related with the cause of the disease.
Patients who suffer from ascites(the accumulation of an amount of fluid in the abdominal cavity) are treated with diuretics-a type of medicine who’s effect is the increase of urine output and implicitly the removement of excessive fluid from the body.
Spontaneous bacterial peritonitis is treated with antibiotics like cefotaxime or ampicilin. Usually the treatment last for 1-2 weeks. In special cases like patients who do peritoneal dialysis the doctor will decide what kind of antibiotic should be administrated.
Patients suffering from ascites due to cancer usually don’t respond to medicine like antibiotics or diuretics. They are treated using a procedure called large volume paracentesis. A needle is inserted into the abdomen and big quantity of fluid is removed from the abdominal cavity.
Secondary peritonitis treatment is directed to the infection causing the disease,that’s why is very important to know the cause of the disease.
Familial Mediterranean fever is usually treated using a medicine named Colchicine which helps reducing the frequency of symptoms.
The treatment of acute peritonitis, in general, consist in intravenous rehydration. If the patient does peritoneal dialysis antibiotics may be administrated or, if the infection is to serious,the catheter must be removed.
When peritonitis is caused by a peptic ulcer or a burst appendix surgery may be necessary so a full exploration of the peritoneum could be done. Surgery is not indicated for spontaneous bacterial peritonitis or for pelvic inflammatory disease.
Surgery is considered the fastest way to eliminate the infection and repair the organs and the tissues which have been damaged.
Also,as a method of treatment,fluid and gas from the stomach or the intestine can be removed by inserting a tube through the nose all the way to the stomach or intestine.
The replacement of fluids and electrolytes may be done intravenously.
To reduce the pain the patient can take analgesics or morphine.
In order to prevent perforation,the patient should take additional fluids and electrolytes parenterally.
In addition to all this a supplementary diet is recommended for the recovery process. This diet should include:
~Vitamin A- helps strengthen the immune system and stops the development of bacteria.
~Vitamin D-studies show that helps improving the immune defense for patients on CAPD.
~Vitamin C and E-also support the immune system and are used for protecting the body against peritonitis complications like the infection of respiratory system.
~Zinc-is very effective in the healing process.
~Glutamine and Arginine-are amino acids which prevent bacteria from growing,protect the lining of the intestine.However the administration of this acids is dangerous because they have as secondary effect the inflammation of the peritoneum a known cause for peritonitis.
~Omega-3 and Omega-6-are fatty acids which increase the resistance to infection.They are found in cold-water fish like salmon or mackerel.
~Chinese herbs can be used associated with antibiotics for treating peritonitis: Rhubarb, Peony root, Bitter orange, Skullcap, Honeysuckle flower, Corydalis root. Other herbs like Echinacea root or Mushrooms help strengthen the immune system. Also Milk thistle and Nettles help protecting the liver.
Specialists recommend these herbs as a supliment for the conventional treatment.
As treatment for peritonitis we can also include homeopathic remedies like:
-Trioxide of Arsenic-recommended for people with swollen abdomen, chills and other symptoms which can become worse at night.
-Deadly nightshade-is recommended for patients who have a high fever, unexpected crises of pain.
-Bushmaster snake-for people with a hot abdomen and a rigidity that comes down to the thigs
Usually,peritonitis caused by infection is treatable with antibiotics. If the treatment hasn’t the effect expected the infection may spread to other parts of the body or, even worse, an intestinal obstruction may occure or shortness of breath.
The antibiotics used most often are ciprofloxacin (750 mg once a week),trimethoprim-sulfamethoxazole (one tablet a day),norfloxacin (400 mg once a day ).
Treated properly, peritonitis has a mortality rate of less than 10%,but untreated is a life-threatning disease and can be fatal.