What is Septic Peritonitis?
Sepsis is basically an intense body reaction, both defensive and dangerous, triggered by an interaction between the body and disease-causing germs. This reaction can cause damage to body tissues due to the body’s extreme protective response, and can lower the body’s ability to defend against other infections, making it easier for new infections to develop.
The signs of sepsis can be very different from one person to another. They rely on various factors, including where the infection originally started in the body, what type of germ caused the infection, how the infection is affecting the body’s organs, the overall health condition of the patient, and how long it takes before treatment has started.
Severe sepsis can arise due to infections acquired either in the community or in healthcare settings. The most common cause of sepsis is pneumonia, which can be contracted in the community. However, within healthcare settings, infections in the abdominal area and urinary tract can also pave the way for sepsis. The most common infections causing sepsis are from germs called Staphylococcus aureus and S pneumoniae (gram-positive pathogens), and Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa (gram-negative microorganisms).
If an infection starts in a particular area within the abdomen, it’s known as an abscess. If the body’s response to the infection starts in the lining of the abdominal cavity, it’s called peritonitis. Both of these can lead to a widespread body response also called peritonitis-induced sepsis. The analysis of this subject revolves around the key aspects of identifying and treating the original infection and dealing with the complications linked to sepsis. One of the severe complications associated could be Severe Septic Peritonitis, a dangerous infection in the lining of the abdomen.
What Causes Septic Peritonitis?
Infections in the usually clean abdominal cavity often happen because harmful germs grow unchecked. This can occur when the gastrointestinal (GI) tract – the path food takes from your mouth to your anus – is damaged in some way. This is often due to it being punctured or torn. The damage can happen because of a long-lasting disease that weakens the tissues, making them more prone to tearing, or because of a sudden illness such as inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis).
Damage to the abdomen can also cause this kind of infection. This can be as a result of injuries, surgery, or even from catheters used in dialysis, a treatment for kidney disease. Less commonly, infections can start in other body parts and spread to the abdominal cavity through the bloodstream, especially in patients with a weak immune system. Another less common cause is spontaneous bacterial peritonitis, which can happen in people whose tissue fluid has built up in their abdomen due to liver disease (cirrhosis), heart failure, or kidney disease.
Risk Factors and Frequency for Septic Peritonitis
Many studies looking at the rate of sepsis caused by peritonitis, an infection in the lining of the abdomen, in certain populations have produced unclear findings that aren’t applicable to the general populace. However, if we focus on the spontaneous bacterial peritonitis (SBP), a certain type of peritonitis, the data suggests a yearly occurrence of about 7% to 30% in patients with ascites, which is an accumulation of fluid in the abdominal cavity.
Signs and Symptoms of Septic Peritonitis
Understanding a patient’s medical history can help identify the source of peritonitis, an inflammation of the thin layer of tissue that covers the inside of the abdomen. Factors that could contribute to this condition include recent abdominal surgery, chronic inflammatory disease, advanced kidney disease, and regular use of drugs that suppress the immune system. It’s essential to properly investigate and evaluate these factors.
Common signs of peritonitis, found in most individuals diagnosed with the condition, include general symptoms like fever, chills, abdominal pain or discomfort, diarrhea, and ileus, which is a disruption of the intestines’ normal propulsive ability. Interestingly, about 30% of people with spontaneous bacterial peritonitis (SBP) do not show any symptoms when they first see a doctor.
During a physical exam, relevant findings may include fever and a tender abdomen when touched. The tenderness often spreads across the abdomen, and the abdominal wall may become stiff in more severe cases. It is critical to carry out a comprehensive examination because other conditions affecting the chest or pelvis can mimic the irritation of the peritoneum, such as infection within the lung lining (empyema) causing irritation of the diaphragm, and inflammation of the bladder or kidney causing pain near the peritoneum.
- Recent abdominal surgery
- Chronic inflammatory disease
- Advanced kidney disease
- Regular use of drugs that suppress the immune system
- General symptoms like fever, chills, abdominal pain or discomfort, diarrhea, and ileus
- About 30% of people with spontaneous bacterial peritonitis (SBP) do not show any symptoms when they first see a doctor
- Fever and a tender abdomen when touched on a physical exam
- Stiff abdominal wall in severe cases
Testing for Septic Peritonitis
Patients can experience a wide variety of symptoms relating to their illness. These can range from mild ailments that progress slowly to intense, fast-moving diseases that affect the entire body. To determine exactly what’s going on, doctors need to look at a patient’s symptoms and use laboratory tests to assist in deciding the best course of treatment. Crucial tests in these cases include:
1. Checking for an increased number of white blood cells
2. Testing for possible signs of kidney or liver dysfunction, which could denote multiple organ failure or pre-existing diseases
3. Blood culture tests, a type of test that checks for bacteria or other organisms in the blood
4. Analysis of peritoneal fluid, which is the liquid that fills the abdominal cavity
The analysis of peritoneal fluid is critical to diagnose a condition known as Spontaneous Bacterial Peritonitis (SBP). The most reliable indicator of SBP is a neutrophil (a type of immune cell) count greater than 250 cells per microliter in this fluid. Additionally, this fluid should be tested to determine its glucose, protein, Lactate Dehydrogenase (LDH), and cell count levels.
Doctors also use something known as the Serum-Ascites Albumin Gradient (SAAG) to understand the fluid better. This test helps in recognizing the type of ascites, which is the accumulation of fluid in the abdomen. If the SAAG is higher than 1.1 grams per deciliter, it indicates that the fluid build-up is due to increased pressure, occurring in conditions such as portal hypertension, congestive heart failure, or Budd-Chiari syndrome. If the SAAG is less than 1.1 grams per deciliter, it often indicates fluid linked to infections, cancers, or inflammatory conditions.
In managing the illness, the doctor often has to monitor the patient for signs of sepsis, a severe response to infection. This includes checking for symptoms of reduced organ function, analyzing lactate levels, watching for signs of brain dysfunction, assessing kidney function, and determining whether supportive measures such as breathing support or blood pressure support are necessary.
Treatment Options for Septic Peritonitis
The main goal of treatment is to identify and handle the harmful agents through the use of antibiotics or surgery. Non-surgical treatment involves the use of broad-spectrum antibiotics, which can fight a wide range of bacteria. This treatment is then adjusted to be more effective against the specific bacteria causing the illness. Other non-surgical treatments include the use of ultrasound or CT scans to guide the drainage of an abscess (a pocket of pus) and the placement of a stent (a small tube used to open a blocked passageway in your body). Supplemental treatments aim to lessen the impact of toxins released by the bacteria, damage to different organs, and inflammation caused by your body’s response to infection, which are all common in the severe infection known as sepsis.
What else can Septic Peritonitis be?
Figuring out the cause of certain symptoms can be tricky because these symptoms can sometimes be vague and can be signs of many different health conditions. It’s important to consider where in the body these symptoms are coming up. For example, symptoms could be stemming from:
- Irritation of the tissue that separates the chest and the abdomen, possibly due to chest infections or diseases affecting the lung lining
- Health problems in the pelvic region, such as bladder inflammation or blockages in the urinary system
- Diseases in the area behind the abdominal organs, like kidney infection or internal bleeding
- Problems with the abdominal wall itself, like an infection or internal bleeding in the muscles that run down your stomach
Furthermore, inflammation can also occur outside of the abdominal cavity due to causes like:
- Chemical irritations from substances such as bile, stomach acid, or blood
- Systemic inflammatory diseases that can also show symptoms in the abdomen, for example, Lupus, Crohn’s disease, or allergic inflammation of the blood vessels
- Certain abnormalities in the blood vessels that can cause inflammation in a wide range of areas, including blood clotting in the mesenteric (the tissues that connect your intestines to the wall of your abdomen) or an inadequate blood supply to the colon
