Acute inflammatory disorders of the abd Flashcards
Peritonitis Definition
spontaneous bacterial peritonitis
transmigration of bacteria
enteric gram-negative bacilli is most common
klebsiella, pneumococcus enterococcus are also common
secondary peritonitis definition
peritonitis from sx,
polymicrobial
penetrating trauma
perforation dt appendicitis, colitis, peptic ulcer dz, diverticulitis, pancreatitis, and cholecystitis
Peritonitis S&S
fever, abd pain w change in mental status dt hepatic encephalopathy
secondary Peritonitis S&S
acute abd pain high fever, N/V constipation abd exam reveals: distention, rebound tender, generalized rigidity, decreased bowel sounds, hyperresonance, Ascites, dyspnea/tachypnea, dehydration
peritonitis diagnostic test
Paracentesis (ascitic fluidO bld cultures: + 25% time WBC: elevated in secondary BUN: increased abd xray: free air, bowel dilation Chests xray: elevated diaphragm
peritonitis paracentesis
evaluate ascitic fluid
peritonitis BUN
increased
peritonitis Bld cultures
+ 25% of time
Peritonitis abd x ray findings
free air, bowel dilation
peritonitis chest xray findings
elevated diaphragm
management of primary peritonitis
ABx: 3rd gen cephalosporin
10 days
management of secondary peritonitis
operative to eliminate source, empiric abx, monitor cultures, IV fluid, monitor vs, urinary output
common cause of appendicitis
fecalith
intestinal parasite
inflammation
neoplasm
early S&S of appendicitis
vague, colicky, periumbilical abd pain, n/v
12-48 hrs pain migrates to RLQ, fever
atypical s&s of appendicitis
indigestion, flatulence, diarrhea, malaise
classic sign of appendicitis
McBurney sign: ae
where is Mcburney sign
: a deep tenderness locatred 2/3 of distance from umbilicus to r anterior superior iliac spine
Rovsing sign
pain illicited on the rlq when you palpate the llq
iliopsoas test
straight leg test that causes pain when you lift the right leg straight up
obturator test
lift a bended knee/ leg upwards
what is peritonitis
Rupture: obstruction persists, pressure increases and wall of lumen becomes weak until it ruptures,
spills bacteria into peritoneum causing peritonitis
S&S of appendicitis
ABd gaurding: early sign of peritoneal irritation
Rebound tenderness
diag labs for appendicitis
lab: wbc, increased CRP, dehydration or fluid/electrolyte imbalance,
UA: r/o genitourinary cond
Urine or serum preg test
diag test for appendicitis
plain abd film: no useful
US: show enlarged appendix w/ diameter >6
abscess: increased echogenic periappendiceal fat and appendicolith
CT: done as fu, if US inconclusive
enlarged appendix, appendiceal wall thickened
>2mm
appendicitis differentials
confused with gastroenteritis and GYB disorders
resemble: diverticulitis, carcinoid of appendix, perforated colon ca, Crohns, perforated peptic ulcer, cholecystitis, mesenteric adenitis
appendicitis tx
classic findings: sx without imaging
atypical presentation: further test to r/o bowel obstruction, ovarian/testicular torsion, kidney stones
appendectomy
acute perforated should be done within 12 hrs of dx
preop tx: iv rehydration, rebalance electrolytes
prophylactic abx for appendicitis
start at diagnosis and <30 min before sx incision
iv dose 2gm cefoxitin/cefotetan
or
3 gm cefazolin + 5 Flagyl
if allergic:
clindamycin + ciprofloxacin, levofloxacin or gentamicin
perforation or gangrene S&S
and tx
generalized peritonitis,
hemodynamic instability
requires: emergency appy w/ irrigation/drainage of abd cavity
appendicitis: post op care
clear liq adv to reg diet as tolerated
dc when afebrile and tolerating diet
abx are not needed post sx
appendicitis: nonoperative tx
stable w/ perforated appendix local symptoms w/ no general peritonitis can be tx non operative. phlegmon tx w/ ivf, abx repeat imaging to follow CT guided percutaneous drainage may need appy anyways
