Is it just a stomach ache? Maybe it's peritonitis! Let's talk.

You probably get a stomach ache sometimes, right? We usually think of it as something minor like gastritis , or something like eating too much. But not all stomach aches are that simple, sometimes they can be a bit more serious and require immediate attention. Peritonitis is one such condition. Although the name may sound a bit complicated, let's talk about it in detail and very simply, shall we? Because being aware of this can be very important for you and your loved ones.

What is the peritoneum? Where is it located?

Okay, first let's look at what the peritoneum is, and where it is located, which is the cause of this disease called peritonitis.

Simply put, the peritoneum is a very thin membrane that lines the inside of your abdomen (the entire area between your chest and waist). Think of it like a thin plastic sheet that helps to keep your organs, like your intestines , liver , and stomach , in place.

There are two main parts of this peritoneum:

1. Parietal peritoneum: This is the layer that covers the inner wall of the abdominal cavity.

2. Visceral peritoneum: This is the membrane that surrounds the organs inside the abdomen (such as the intestines and stomach).

Between these two membranes is a small space called the peritoneal cavity . It contains a small amount of fluid that helps the organs slide around without rubbing against each other as they move. The peritoneum also provides some support for the organs and helps them stay in place.

So, what is Peritonitis?

Now you have a rough idea of ​​what the peritoneum is. Peritonitis is the inflammation of the peritoneum, meaning it becomes swollen, red, and infected . In medicine, words that end in "-itis" usually refer to inflammation. For example, appendicitis and gastritis.

This inflammation is most often caused by a bacterial infection. But sometimes it can also be caused by a fungal infection or other causes. However, when this happens, it can cause a lot of trouble inside the stomach.

What are the causes of Peritonitis?

There are many possible causes of peritonitis. Let's break them down into categories.

Most common cause: Infections

This is the main reason. There are types of this too.

• Secondary Peritonitis: This is the most common type. This occurs when an infection spreads to the peritoneum from a problem in another organ within the abdomen.
• Appendicitis: You've probably heard of appendicitis. It's when a part of the small intestine called the appendix becomes inflamed and infected. If it's not treated properly, it can rupture, allowing the germs and pus inside to spread throughout the abdominal cavity. That's when peritonitis develops.
• Gastric or Bowel Perforation: A gastric ulcer can become severe and become perforated. Or, a condition like diverticulitis can cause the intestinal wall to become weak and become perforated. Sometimes, this can also happen due to an injury or accident. When this hole is made, stomach acid and intestinal contents leak into the peritoneal cavity, causing a serious infection.
• Gallbladder rupture: Problems like gallstones can cause the gallbladder to become infected and sometimes rupture. This allows bile from the gallbladder to leak into the peritoneal cavity, causing peritonitis.
• Pancreatitis: The pancreas is an important gland in our body. When it becomes inflamed (Pancreatitis), the enzymes released from it can damage the peritoneum and cause peritonitis.
• Post-surgical infection: After abdominal surgery, sometimes an infection can spread to the peritoneum through the wound or in other ways.
• Abdominal trauma: Peritonitis occurs when the abdominal organs are damaged by something like a car accident or a knife stab wound, and their contents leak into the peritoneal cavity.
• Gynecological problems: In women, conditions such as infection of the fallopian tubes (salpingitis), aka Pelvic Inflammatory Disease (PID) , can cause the infection to spread to the peritoneum.

• Spontaneous Bacterial Peritonitis (SBP): This is a special case. It is usually seen in people with liver disease (e.g. cirrhosis) that causes ascites. Here, without an obvious hole or tear in the abdomen, the fluid in the abdomen becomes infected with bacteria, causing peritonitis.

• For those on Peritoneal Dialysis (PD): Some patients with kidney failure undergo peritoneal dialysis as a treatment. In this procedure, a special fluid is injected into the peritoneal cavity to remove waste products from the blood. During this procedure, germs can sometimes enter through the catheter, causing peritonitis.

Non-infectious causes (Sterile Peritonitis)

This is a little less common. What happens here is that the peritoneum becomes inflamed due to a chemical substance (e.g. bile, blood, a substance used during surgery). In this case, there is no bacterial infection at first, but an infection can join later.

What are the symptoms of peritonitis? How do you recognize it?

The symptoms of peritonitis can come on suddenly or develop gradually. But it's important to be aware of these symptoms, because this is an emergency!

"If you have unbearable, persistent stomach pain along with a fever, don't dismiss it as normal. See a doctor immediately."

The main features are these:

• Severe abdominal pain: This is the main and most severe symptom. Although it may initially only hurt where the infection started, the pain spreads throughout the abdomen over time. The pain may also increase when moving, coughing, or breathing.
• Tenderness: When a doctor palpates the abdomen, there is severe pain.
• Abdominal rigidity /guarding: The abdominal muscles become rigid and stiff, like a plank. This is because the body is trying to protect itself from inflammation inside.
• Fever and chills: Fever occurs because of an infection.
• Nausea and Vomiting: These can occur along with loss of appetite.
• Abdominal bloating/distension: The stomach feels swollen and bloated.
• Fatigue, excessive tiredness.
• Rapid heartbeat (Tachycardia).
• Difficulty breathing: Difficulty breathing due to stomach pain.
• Thirst, Dry mouth.
• Reduced urine output.
• Constipation or Diarrhea: Some people may also experience this.

Imagine, a friend of yours, let's say Nimali, suddenly has a severe stomach ache, fever and chills. She thinks, 'Oh, this is just a normal stomach ache' and stays to the side. But the pain gets worse and worse, her stomach hurts so much that she can't even touch it, and her stomach feels bloated. At that point, it could be a sign of a serious condition like peritonitis. In that case, the best thing to do is to go to a hospital without delay .

What does a doctor do if peritonitis is suspected?

When you go to see a doctor with these symptoms, he or she will first ask you about your symptoms (history taking). Things like when the pain started, how it started, and whether you have other illnesses.

Then a physical examination is performed. The abdomen is specifically examined for tenderness, abdominal rigidity, and bowel sounds.

Tests to confirm the diagnosis:

If, after these symptoms and tests, the doctor suspects peritonitis, he or she may perform several more tests to confirm it.

• Blood tests: This mainly checks the number of white blood cells (WBC) in the blood. This number will increase if there is an infection. It also checks for inflammatory markers such as CRP (C-Reactive Protein) . It can also check kidney function and dehydration.
• Abdominal X-ray: This can be used to see if there is a hole in the intestine and air has entered the peritoneal cavity (pneumoperitoneum).
• Ultrasound scan or CT scan: These scans can show more clearly what's going on inside the abdomen. They can help find out the cause of peritonitis (e.g. appendicitis, gallbladder disease), whether the abdomen is full of fluid (ascites), or whether an abscess has formed.
• Paracentesis: If there is ascitic fluid in the abdomen, a small amount of the fluid is removed with a thin needle and sent to a laboratory for testing. This is used to check for bacteria, pus, and what types of cells are present. This is especially important for diagnosing SBP.

How is Peritonitis treated?

The most important thing to remember is this: Peritonitis is a medical emergency! Therefore, it is important to get to the hospital and start treatment immediately. Delaying treatment can be life-threatening.

There are several treatment methods:

• Antibiotics: These are given to kill the bacteria that caused the infection. They are often given intravenously (IV) first, where they are quickly absorbed into the body. Sometimes more than one type of antibiotic may be given.
• Surgery:
• In many cases, especially in cases of secondary peritonitis, surgery is required.
• Surgery is done to treat the underlying problem that caused the peritonitis. For example, if the appendix is ​​ruptured, it is removed (appendectomy), if there is a hole in the intestine, it is closed, if the gallbladder is ruptured, it is removed.
• Also, during the surgery, all the pus, waste, and infected fluids inside the abdomen are thoroughly washed out. This is also called peritoneal lavage .
• Supportive care:
• Pain relievers: Control severe pain.
• Intravenous saline (IV fluids): Things like vomiting and fever can cause dehydration, which is caused by the loss of water and salts from the body. Saline is given to stop this.
• Oxygen: If you have difficulty breathing.
• Sometimes a tube (Nasogastric tube - NG tube) is inserted through the nose to drain the contents of the stomach (air, liquid). This helps reduce vomiting and bloating.
• Treatment in an intensive care unit (ICU) may also be necessary, especially if the patient's condition is serious.

Is Peritonitis dangerous? What are the complications?

Yes, peritonitis is a very serious, life-threatening condition. That's why prompt treatment is so important. If left untreated or delayed, serious complications can occur.

• Sepsis and septic shock: A condition in which the infection enters the bloodstream and spreads throughout the body, damaging organs and causing blood pressure to drop dangerously low. This can be fatal.
• Intra-abdominal Abscess: Pus can collect in places inside the peritoneum and form abscesses. This also needs to be treated, possibly with another surgery or a tube to drain the pus.
• Bowel adhesions: As the inflammation heals, parts of the intestines can stick together or to the peritoneum. These adhesions can later cause bowel obstruction .
• Organ failure: The function of vital organs, especially the kidneys, liver, and lungs, may be impaired.
• Wound infection: The surgical wound can become infected.
• If not treated quickly, it can even lead to death. This is the most dangerous thing.

Can Peritonitis be prevented?

Although it cannot be completely avoided, there are things you can do to reduce the risk.

• If you have conditions that can cause peritonitis (e.g. appendicitis, stomach ulcers, gallstones), it is very important to seek prompt and proper medical attention . Don't ignore the symptoms.
• People undergoing peritoneal dialysis should take the utmost care with hygiene as instructed by doctors and nurses during the procedure. Things like keeping the area around the catheter clean and washing your hands thoroughly are important.
• After abdominal surgery, if you have signs of infection, such as pus coming out of the wound, redness, swelling, or fever , you should tell your doctor immediately.
• It is important for people with liver disease, especially those with ascites, to take their medications as prescribed by their doctor and to monitor their SBP symptoms.

Finally, things to remember (Take-Home Message)

Okay, so we've talked a lot about peritonitis today. It's really important to keep these things in mind.

• If you have severe, unbearable stomach pain, especially if it comes with a fever, don't assume it's something simple. It could be a sign of a serious condition like peritonitis.
• Peritonitis is a medical emergency. Time is the difference between life and death.
• Early diagnosis and prompt treatment can save lives and reduce complications.
• If you or someone you know has these symptoms, do not hesitate to go to a hospital or see a doctor immediately.

I hope you found this information useful. Stay healthy!

` Peritonitis, abdominal pain, abdominal cavity, infection, appendicitis, surgery