The nurse is caring for a client admitted with peritonitis. which finding in the medical record

Diagnosis

To diagnose peritonitis, your doctor will talk with you about your medical history and perform a physical exam. When peritonitis is associated with peritoneal dialysis, your signs and symptoms, particularly cloudy dialysis fluid, may be enough for your doctor to diagnose the condition.

In cases of peritonitis in which the infection may be a result of other medical conditions (secondary peritonitis) or in which the infection arises from fluid buildup in your abdominal cavity (spontaneous bacterial peritonitis), your doctor may recommend the following tests to confirm a diagnosis:

• Blood tests. A sample of your blood may be drawn and sent to a lab to check for a high white blood cell count. A blood culture also may be performed to determine if there are bacteria in your blood.
• Imaging tests. Your doctor may want to use an X-ray to check for holes or other perforations in your gastrointestinal tract. Ultrasound also may be used. In some cases, your doctor may use a computerized tomography (CT) scan instead of an X-ray.
• Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of the fluid in your peritoneum (paracentesis), especially if you receive peritoneal dialysis or have fluid in your abdomen from liver disease. If you have peritonitis, examination of this fluid may show an increased white blood cell count, which typically indicates an infection or inflammation. A culture of the fluid may also reveal the presence of bacteria.

The above tests may also be necessary if you're receiving peritoneal dialysis and a diagnosis of peritonitis is uncertain after a physical exam and an examination of the dialysis fluid.

Treatment

Spontaneous bacterial peritonitis can be life-threatening. You'll need to stay in the hospital. Treatment includes antibiotics and supportive care.

You'll also need to stay in the hospital for peritonitis that's caused by infection from other medical conditions (secondary peritonitis). Treatment may include:

• Antibiotics. You'll likely be given a course of antibiotic medication to fight the infection and prevent it from spreading. The type and duration of your antibiotic therapy will depend on the severity of your condition and the kind of peritonitis you have. You may be given an antibiotic that treats a wide spectrum of bacteria until doctors have more information about the specific bacteria causing your infection. Then they can more narrowly target your antibiotic.
• Surgery. Surgery is often needed to remove infected tissue, treat the underlying cause of the infection, and prevent the infection from spreading, especially if peritonitis is due to a ruptured appendix, stomach or colon.
• Other treatments. Depending on your signs and symptoms, your treatment while in the hospital will likely include pain medications, fluids given through a tube (intravenous fluids), oxygen and, in some cases, a blood transfusion.

If you're undergoing peritoneal dialysis

If you have peritonitis, your doctor may recommend that you receive dialysis in another way for several days while your body heals from the infection. If peritonitis persists or recurs, you may need to stop having peritoneal dialysis entirely and switch to a different form of dialysis.

June 18, 2020

1. Yu ASL, et al., eds. Peritoneal dialysis. In: Brenner & Rector's The Kidney. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed March 20, 2020.
2. Ferri FF. Peritonitis, secondary. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed March 17, 2020.
3. Treatment methods for kidney failure: Peritoneal dialysis. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). http://kidney.niddk.nih.gov/KUDiseases/pubs/peritoneal/index.aspx. Accessed March 20, 2020.
4. Runyon BA. Spontaneous bacterial peritonitis in adults: Treatment and prophylaxis. https://www.uptodate.com/contents/search. Accessed March 13, 2020.
5. Acute abdominal pain. Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_abdominal_pain.html?qt=&sc=&alt=. Accessed March 13, 2020.
6. Picco MF (expert opinion). Mayo Clinic. March 24, 2015.
7. Doherty GM, ed. Peritoneal cavity. In: Current Diagnosis & Treatment: Surgery. 14th ed. McGraw-Hill Education; 2015. https://accessmedicine.mhmedical.com. Accessed March 13, 2020.
8. AskMayoExpert. Spontaneous bacterial peritonitis (adult). Mayo Clinic; 2019.
9. Runyon BA. Spontaneous bacterial peritonitis in adults: Diagnosis. https://www.uptodate.com/contents/search. Accessed March 13, 2020.
10. Feehally J, et al., eds. Complications of peritoneal dialysis. In: Comprehensive Clinical Nephrology. 6th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed March 20, 2020.
11. Salzer, WL. Peritoneal dialysis-related peritonitis: Challenges and solutions. International Journal of Nephrology and Renovascular Disease. 2018; doi:10.2147/IJNRD.S123618.
12. Spontaneous bacterial peritonitis (SBP). The Merck Manual Professional Edition. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/spontaneous-bacterial-peritonitis-sbp. Accessed March 13, 2020.
13. Greenberger NJ, et al., eds. Ascites & spontaneous bacterial peritonitis. In: Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. 3rd ed. McGraw-Hill Education; 2016. https://accessmedicine.mhmedical.com. Accessed March 17, 2020.
14. Burkart JM. Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis. https://www.uptodate.com/contents/search. Accessed March 13, 2020.
15. Burkart JM. Risk factors and prevention of peritonitis in peritoneal dialysis. https://www.uptodate.com/contents/search. Accessed March 13, 2020.
16. Li PK, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International. 2016; doi:10.3747/pdi.2016.00078.
17. Rajan E (expert opinion). Mayo Clinic. June 1, 2020.

Related

Associated Procedures

Products & Services