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Peritonitis

Acute abdomen; Spontaneous bacterial peritonitis; SBP; Cirrhosis - spontaneous peritonitis

Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

Causes

Peritonitis is caused by a collection of blood, body fluids, or pus in the belly (abdomen).

One type is called spontaneous bacterial peritonitis (SPP). It occurs in people with ascites. Ascites is the buildup of fluid in the space between the lining of the abdomen and the organs. This problem is found in people with long-term liver damage, certain cancers, and heart failure.

Peritonitis may be a result of other problems. These include:

  • Trauma or wounds to the belly
  • Ruptured appendix
  • Ruptured diverticula
  • Infection after any surgery in the belly

Symptoms

The belly is very painful or tender. The pain may become worse when the belly is touched or when you move.

Your belly may look or feel bloated. This is called abdominal distention.

Other symptoms may include:

  • Fever and chills
  • Passing little or no stools or gas
  • Excessive fatigue
  • Passing less urine
  • Nausea and vomiting
  • Racing heartbeat
  • Shortness of breath

Exams and Tests

The health care provider will perform a physical exam. The abdomen is usually tender. It may feel firm or "board-like." People with peritonitis usually curl up or refuse to let anyone touch the area.

Blood tests, x-rays, and CT scans may be done. If there is a lot of fluid in the belly area, the provider may use a needle to remove some and send it for testing.

Treatment

The cause must be identified and treated right away. Treatment typically involves surgery and antibiotics.

Possible Complications

Peritonitis can be life threatening and may cause complications. These depend on the type of peritonitis.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of peritonitis.

References

Kuemmerle JF. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 142.

Levinson ME, Bush LM. Peritonitis and intraperitoneal abscesses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 76.

Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline: management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. PMID: 23463403 www.ncbi.nlm.nih.gov/pubmed/23463403.

    • Peritoneal sample

      Peritoneal sample - illustration

      The peritoneum is the membrane lining the abdominal cavity.

      Peritoneal sample

      illustration

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      Abdominal organs - illustration

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      Abdominal organs

      illustration

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      Gastroschisis repair - series

      Presentation

      • Peritoneal sample

        Peritoneal sample - illustration

        The peritoneum is the membrane lining the abdominal cavity.

        Peritoneal sample

        illustration

      • Abdominal organs

        Abdominal organs - illustration

        The stomach and intestines are the main organs of digestion, coverting and breaking down food into substances which are either absorbed by or excreted from the body.

        Abdominal organs

        illustration

      • Gastroschisis repair - series

        Presentation

      Review Date: 2/27/2016

      Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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