Confirming the Disease Name
Peritonitis (Peritonitis) — This is the medically accurate disease name. It is defined as inflammation of the peritoneum, and its clinical presentation and treatment vary depending on the cause and severity.
1) Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A condition in which inflammation develops in the peritoneum, the thin membrane covering the abdominal cavity and internal organs. Infection by bacteria or other organisms, or noninfectious irritants such as blood, bile, or urine, can cause serous fluid, fibrin, cells, and pus to accumulate in the abdominal cavity and trigger a systemic inflammatory response in the peritoneum.
- Main causes
- Infectious: Intestinal perforation (acute appendicitis, perforation of a peptic ulcer, intestinal perforation), gallbladder perforation, rupture of an intra-abdominal organ, intrauterine infection, etc. Caused by the entry of bacteria into the abdominal cavity.
- Noninfectious: Intra-abdominal bleeding, leakage of bile or urine, irritation after trauma or surgery, etc. (Secondary infection may occur after sterile irritation.)
- Specific type: Spontaneous bacterial peritonitis in patients with cirrhosis.
- Main symptoms: Severe abdominal pain (localized or throughout the abdomen), abdominal tenderness and rebound tenderness, abdominal rigidity (hard as a board), fever, vomiting and nausea, abdominal distension, tachycardia and hypotension (signs of shock), and difficulty breathing. Pain may decrease in the terminal stage, but signs of systemic weakness and sepsis may become severe.
- Test findings: Increased white blood cell count, electrolyte and acid-base abnormalities, high white blood cell count, low pH, and protein changes in ascitic fluid or intra-abdominal drainage, and possible positive blood or ascitic fluid cultures.
2) Treatment Methods
- General principles: Elimination of the cause ("source control" of the primary lesion), systemic support (fluid and electrolyte correction, respiratory and circulatory support), and administration of appropriate antibiotics.
- Initial emergency treatment (indications for the emergency department/admission)
- Fasting (NPO), oxygen and intravenous fluids (comprehensive support in cases of shock), and control of pain and vomiting
- Broad-spectrum intravenous antibiotics (including coverage for gram-negative bacteria and anaerobes) — antibiotics are adjusted according to the cause and local antibiotic susceptibility; the specific drug and dosage are determined by the attending physician.
- Nonsurgical treatment
- Image-guided percutaneous drainage of a localized intra-abdominal abscess
- For specific causes such as bile leakage, blocking the leakage with endoscopic stent placement or similar procedures
- Surgical treatment
- Surgical source control according to the cause, including suturing or resection of the perforation site, removal of contaminants and abdominal lavage, and, when necessary, bowel resection or cholecystectomy
- In severe cases, repeated lavage or management in the intensive care unit
- Monitoring during hospitalization: Hemodynamics (blood pressure and pulse), urine output, acid-base status and electrolytes, and adjustment of antibiotics according to blood culture results
- Precautions (including self-care)
- Continue fasting until the cause and treatment have been determined
- If fever, severe abdominal pain, dizziness, hypotension, or difficulty breathing develops, visit a hospital immediately
- Patients with chronic liver disease have a higher risk of spontaneous bacterial peritonitis — if ascites is present, fever or abdominal pain requires immediate evaluation
3) Checkpoints Before an Outpatient Visit (Including Example Questions)
- Items to prepare
- List of medications currently being taken (including antibiotics, anticoagulants, and immunosuppressants) and any drug allergies
- Medical history: Recent abdominal surgery, abdominal inflammation, ulcers, or gallbladder disease; cirrhosis or ascites; and recent trauma
- Symptom records: Time symptoms began (exact time), location and intensity of pain (a pain diagram may be used), whether fever is present and measured temperature, vomiting, changes in bowel movements, and urinary symptoms
- Recent test results (such as blood tests and abdominal ultrasound/CT/X-ray results) or image files
- Items to record during the outpatient visit
- Changes in pain (when moving, breathing, or pressing), whether food has been consumed, and any recent history of antibiotic use
- Examples: “What time did the symptoms (abdominal pain, fever, etc.) begin?”, “Have you recently had abdominal surgery or trauma?”, “Have you ever been diagnosed with ascites or liver disease?”
4) Examples of General Questions to Ask the Doctor
- “What is the suspected cause of this condition? What additional tests or imaging are needed?”
- “Which antibiotic do you recommend, and what is the expected treatment duration? What are the side effects?”
- “Please explain whether surgery is necessary or whether nonsurgical treatment is possible.”
- “What is the likelihood of complications after recovery (such as an intra-abdominal abscess, adhesions, or intestinal obstruction), and how can they be prevented?”
5) Examples of Disease-Specific Questions
- (If perforation is suspected) “Were signs of perforation confirmed on imaging? Is immediate surgery recommended?”
- (For patients with cirrhosis and ascites) “Is paracentesis (ascitic fluid testing) needed to determine whether I have spontaneous bacterial peritonitis? Are preventive antibiotics or other preventive measures needed?”
Additional Information
- Peritonitis may be an urgent condition. If you have severe abdominal pain, high fever, vomiting, hypotension, or similar symptoms, you should visit the emergency department without delay.
- The diagnostic and treatment items presented are general information and may need to be reviewed or modified depending on the individual’s condition. Consult your healthcare provider.