Gastrointestinal

Question 1

What is peritonitis?

Answer 1

Inflammation of the peritoneum, the lining of the abdomen

Question 2

What are the signs of peritonitis?

Answer 2

-guarding
-rigidity of abdominal wall muscles
-rebound tenderness
-coughing test for pain
-percussion tenderness

Question 3

What is localised peritonitis caused by?

Answer 3

Underlying organ inflammation, for example, appendicitis or cholecystitis

Question 4

What can cause generalised peritoniits?

Answer 4

Generalised peritonitis may be caused by perforation of an abdominal organ (e.g. perforated duodenal ulcer or ruptured appendix) releasing the contents into the peritoneal cavity and causing generalised inflammation of the peritoneum.

Question 5

What is spontaneous bacterial peritonitis associated with?

Answer 5

Spontaneous bacterial peritonitis is associated with infection of ascites in patients with liver disease. This is treated with broad-spectrum antibiotics and carries and poor prognosis.

Question 6

What blood tests are useful in patients presenting with an acute abdomen?

Answer 6

-FBC- Hb and WBC
-U&Es- electrolyte imbalance and kidney function
-LFTs- biliary and hepatic
-CRP- indication of inflammation and infection
-Amylase- gives an indication of inflammation of the pancreas in acute pancreatitis
-International normalised ration (INR)- gives an indication of the synthetic function of the liver and is essential in establishing their coagulation prior to procedures.
-Serum calcium- to score acute pancreatitis and for clotting and cardiac function
-Serum human chorionic gonadotropin (hCG)- pregnancy
-ABG- for lactate (indication of tissue ischaemia) and pO2 (used for scoring in acute pancreatitis)
-Serum lactate- gives and indication of tissue ischaemia. It is a product of anaerobic respiration and can also be raised in dehydration or hypoxia.
-Group and save- in case they need a blood transfusion
-Blood cultures if infection is suspected

Question 7

What imaging investigations can be used in acute abdomen?

Answer 7

Abdominal x-ray can provide evidence of bowel obstruction by showing dilated bowel loops.

Erect chest x-ray can demonstrate air under the diaphragm when there is an intra-abdominal perforation. This is caused by air within the peritoneal cavity (pneumoperitoneum).

Abdominal ultrasound can be useful in checking for gallstones, biliary duct dilatation and gynaecological pathology.

CT scans are often required to identify the cause of an acute abdomen and determine correct management.

Question 8

Initial management of acute abdomen?

Answer 8

ABCDE assessment
Alert seniors of unwell patients: escalating to the registrar, consultant and critical care as required
Nil by mouth if surgery may be required or they have features of bowel obstruction
NG tube in cases of bowel obstruction
IV fluids if required for resuscitation or maintenance
IV antibiotics if infection is suspected
Analgesia as required for pain management
Arranging investigations as required (e.g., bloods, group and save and scans)
Venous thromboembolism risk assessment and prescription if indicated
Prescribing regular medication on the drug chart if they are being admitted (some may need to be withheld)

Question 9

What are the causes of peritonitis?

Answer 9

-burst/perforated stomach ulcer
-burst/perforated appendix
-Crohn’s or diverticulitis
-pancreatitis
-surgery
-injury
-pelvic inflammatory disease
-cirrhosis

Question 10

treatment of peritonitis

Answer 10

IV antibiotics

Question 11

Complications of peritonitis?

Answer 11

-sepsis
-abnormal clotting of blood
-scar tissue in peritoneum
-acute respiratory distress syndrome (a severe infection of the lungs)