Diagnosis of Peritonitis
If you have any symptoms of peritonitis, call your doctor right away. Seeking prompt medical attention is especially important for peritoneal dialysis patients who have a combination of abdominal pain and a clouding of the peritoneal fluid, which is caused by a buildup of infection-fighting white blood cells.
Because peritonitis can rapidly lead to potentially fatal complications such as sepsis and septic shock, which causes a massive drop in blood pressure, organ failure, and death, it’s essential to receive a quick diagnosis followed by appropriate treatment.
Your doctor will ask about your symptoms and medical history, and conduct a thorough physical examination, including assessment of tension and tenderness in the abdomen.
Diagnostic tests for peritonitis may include:
- Blood and urine tests
- Imaging studies such as X-rays and computerized tomography (CT) scans
- Exploratory surgery
Your doctor also may perform a paracentesis, a procedure in which fluid from the abdominal cavity is withdrawn through a thin needle and checked for infection. Paracentesis is useful for identifying primary spontaneous peritonitis and secondary peritonitis caused by pancreatitis.
Treatments for Peritonitis
If you're diagnosed with peritonitis, you'll be admitted to a hospital. Typically, you'll immediately start receiving intravenous antibiotics or antifungal medications to treat the infection. Additional supportive treatments will be necessary if organ failure from sepsis develops as a complication of the infection. Such treatments may include intravenous fluids, drugs to maintain blood pressure, and nutritional support.
If you have peritoneal dialysis-associated peritonitis, you may receive medications that are injected directly into the peritoneal tissue, a strategy that some studies have reported to be more effective than intravenous medications. Until the peritonitis is cured, you will need to use another method of dialysis, such as hemodialysis.
In many cases, emergency surgery is required, especially if peritonitis has been caused by conditions such as appendicitis, a perforated stomach ulcer, or diverticulitis. Infected tissue such as a burst appendix or abscess will be surgically removed. So will any part of the peritoneal tissue that has been seriously damaged by infection.
During your hospitalization, you will be closely monitored for signs of sepsis and septic shock, which usually require immediate transfer to an intensive care unit.
Although peritonitis can be a complication of peritoneal dialysis, it's much less common than it used to be because of improved technology and self-care techniques that are taught during initial training.
If you're receiving peritoneal dialysis, you can lower your risk of peritonitis by following these tips:
- Thoroughly wash your hands, including the areas between your fingers and under your fingernails, before touching the catheter.
- Wear a mouth/nose mask during exchanges.
- Observe the proper sterile exchange technique.
- Apply an antibiotic cream to the catheter exit site every day.
Immediately report any possible contamination of your dialysis fluid or catheter to your peritoneal dialysis nurse. In many cases, a single dose of antibiotics can prevent a contamination from turning into an infection.