10. Peritonitis (diagnosis and treatment)

Question 1

Causes of localized peritonitis

Answer 1

• Appendicitis
• Cholecystitis
• Diverticulitis
• Salpingitis

Question 2

Causes of generalized peritonitis

Answer 2

• Bacterial infection
• Cirrhosis/ascites
• Renal failure patient with frequent peritoneal dialysis
• Chemical peritonitis due to spillage of bile, blood and gastric contents

Perforations can cause both bacterial infections and chemical damage

Question 3

Primary peritonitis cause

Answer 3

Streptococcal infection through blood stream (rare)

Question 4

Clinical features - signs and symptoms

Answer 4

• Fever
• Loss of appetite
• Severe generalised abdominal pain, radiating to the shoulders and back
• Tachycardia
• Generalised abdominal tenderness with guarding and rigidity

Question 5

Diagnosis

Answer 5

• surgery is contraindicated in acute pancreatitis so this must be excluded - abdominal CT and look for increased amylase
• lab values will have increased CRP and neutrophils

Question 6

Early treatment

Answer 6

IV antibiotics if diagnosis is not clear and surgery is indicated (exluded pancreatitis)

Question 7

Treatment of upper GI perforation

Answer 7

• Resuscitation

* Conservative treatment: IV PPI, limited oral intake of food, physiotherapy

Question 8

Secondary peritonitis causes

Answer 8

• Acute perforated appendicitis (most common cause in patients under 45)
• Acute perforated diverticular disease (most common cause in the elderly)
• Upper GI performation
• Tumour perforation (colon, gastric)
• Perforated ischaemic bowel
• Acute pancreatitis
• Peritoneal dialysis
• Post-operative

Question 9

Perforated tumour treatment

Answer 9

Must be resected, even if only pallative

Question 10

Perforated diverticular disease treatment

Answer 10

• IV antibiotics

* Resection of the affected segment

Question 11

Primary or dialysis related peritonitis

Answer 11

Lavage of all quadrants and IV-antibiotic