Peritonitis is an inflammation of the peritoneum, the thin membrane that lines the abdominal wall and covers the organs within. The inflammation is caused by a bacterial or fungal infection of this membrane. There are two major types of peritonitis. Primary peritonitis is caused by the spread of an infection from the blood and lymph nodes to the peritoneum. This type of peritonitis is rare -- less than 1% of all cases of peritonitis are primary. The more common type of peritonitis, called secondary peritonitis, is caused when the infection comes into the peritoneum from the gastrointestinal or biliary tract. Both cases of peritonitis are very serious and can be life threatening if not treated quickly.

The signs and symptoms of peritonitis include:

• Swelling and tenderness in the abdomen with pain ranging from dull aches to severe, sharp pain
• Fever and chills
• Loss of appetite
• Thirst
• Nausea and vomiting
• Limited urine output
• Inability to pass gas or stool

Primary peritonitis is usually caused by liver disease. Fluid builds up in the abdomen, creating a prime environment for the growth of bacteria.

Secondary peritonitis is caused by other conditions that allow bacteria, enzymes, or bile into the peritoneum from a hole or tear in the gastrointestinal or biliary tracts. Such tears can be caused by pancreatitis, a ruptured appendix, stomach ulcer, Crohn's disease, or diverticulitis. Peritoneal dialysis, which uses the blood vessels in the peritoneum to filter waste from your blood when your kidneys are not able to do so, also may cause peritonitis.

The following factors may increase the risk for primary peritonitis:

• Liver disease (cirrhosis)
• Fluid in the abdomen
• Weakened immune system
• Pelvic inflammatory disease

Risk factors for secondary peritonitis include:

• Appendicitis (inflammation of the appendix)
• Stomach ulcers
• Torn or twisted intestine
• Pancreatitis
• Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
• Injury caused by an operation
• Peritoneal dialysis
• Trauma

Peritonitis can be life threatening, so the doctor will first conduct a physical examination to determine whether you need surgery to correct the underlying problem. The doctor will feel and press the abdomen to detect any swelling and tenderness as well as signs that fluid has collected in the area. The doctor may also listen to bowel sounds and check for difficulty breathing, low blood pressure, and signs of dehydration. The following procedures also may be performed:

• Blood tests -- to see if there is bacteria present in your blood
• Samples of fluid from the abdomen -- identify the bacteria causing the infection
• CT scan -- identifies fluid in the abdomen, or an infected organ
• X-rays -- detect air in the abdomen, which indicates that an organ may be torn or perforated

The best way to prevent serious complications from peritonitis is to seek medical attention as soon as symptoms appear. If you are receiving peritoneal dialysis, you can help avoid peritonitis by cleaning the area around the catheter with antiseptic and washing your hands before touching the catheter.

Peritonitis is a potentially life-threatening condition, and you should see immediate emergency medical attention when symptoms occur. You will likely need to be hospitalized for treatment. You may need surgery to remove the source of infection, such as an inflamed appendix, or to repair a tear in the walls of the gastrointestinal or biliary tract. Antibiotics are used to control infection. Integrative therapies may also be used for supportive care when recovering from peritonitis.

Medications

Your doctor will prescribe antibiotics to kill bacteria and prevent the infection from spreading. The antibiotics prescribed vary, depending on the type of peritonitis and the organism causing the condition.

Surgery and Other Procedures

People with peritonitis often need surgery to remove infected tissue and repair damaged organs.

Nutrition and Dietary Supplements

Peritonitis is a medical emergency and should be treated by a medical doctor. Do not try to treat peritonitis with herbs or supplements. However, a comprehensive treatment plan for recovering from peritonitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

When recovering from any serious illness, it is important to follow good nutrition habits:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Ask your doctor about taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Probiotic supplement (containing Lactobacillus acidophilus among other species), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Probiotics can be especially helpful when taking antibiotics, because probiotics can help restore the balance of "good" bacteria in the intestines.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs can be used as a supportive therapy when you are recovering from peritonitis, but do not use herbs alone to treat peritonitis. Ask your doctor before taking any of the herbs listed below.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, to reduce inflammation. Cat's claw also has antibacterial and antifungal effects.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for antibacterial and antifungal effects. You may also prepare teas from the leaf of this herb.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for liver health.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for peritonitis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Belladonna -- for people who are hypersensitive to touch, have sudden attacks of pain that come and go, and have a high fever
• Arsenicum album -- for people with a swollen abdomen, unquenchable thirst, extreme chills, and symptoms that worsen at night

Prognosis and Complications

Complications from peritonitis can include:

• Sepsis -- an infection throughout the blood and body that can cause shock and multiple organ failure
• Abnormal clotting of the blood (generally due to significant spread of infection)
• Formation of fibrous tissue in the peritoneum
• Adult respiratory distress syndrome -- a severe infection of the lungs

The prognosis for peritonitis depends on the type of the condition. For example, the outlook for people with secondary peritonitis tends to be poor, especially among the elderly, people with compromised immune systems, and those who have had symptoms for longer than 48 hours before treatment. The long-term outlook for people with primary peritonitis due to liver disease also tends to be poor. However, the prognosis for primary peritonitis among children is generally very good after treatment with antibiotics.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Schwartz SI, et al. Principles of Surgery. 8th ed. Vol. 2. New York, NY: McGraw-Hill; 2005.

Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008 Sep;34(9):1580-92.

Tok D, Ilkgul O, Bengmark S, Aydede H, Erhan Y, Taneli F, et al. Pretreatment with pro- and synbiotics reduces peritonitis-induced acute lung injury in rats. J Trauma. 2007 Apr;62(4):880-5.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Yeh SL, Lai YN, Shang HF, Lin MT, Chiu WC, Chen WJ. Effects of glutamine supplementation on splenocyte cytokine mRNA expression in rats with septic peritonitis. World J Gastroenterol. 2005 Mar 28;11(12):1742-6.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Yue GG, Fung KP, Tse GM, Leung PC, Lau CB. Comparative studies of various ganoderma species and their different parts with regard to their antitumor and immunomodulating activities in vitro. J Altern Complement Med. 2006 Oct;12(8):777-89.