Peritoneal Disorders

Question 1

Peritoneal cavity

parietal peritoneum lined w

Visceral peritoneum

Omentum

Answer 1

mesothelium

Lining encloses ab organs

Vascularized, mobile, double fold of peritoneum
Seals off leaking viscus/infection

Question 2

Paracentesis therapeutic effect

Normal fluid values

SG
Protein
WBC

Answer 2

large volume, relieve abdominal distension

1.016
3
<3000

Question 3

Chylous ascites

Lipid rich lymph in peritoneal cavity via

When milky, TG levels above

Cause

Answer 3

obstruction of lymphatic channels

1000

malignancy (lymphoma), post operative trauma

Question 4

Pancreatic ascites

Accumulation of panc secretions bc of

Pain is absent bc

Amylase levels

Answer 4

disrupted panc duct, pseudocysts

panc enzymes absent

> 1000

Question 5

Bile ascites

cause

Sterile

Characteristics

Answer 5

Comp of biliary surgery/liver biopsy/ab trauma

absent ab pain/fever/leuk- indicates secondary infection

Ascities to serum bilirunin >1

Question 6

Tuberculous peritonitis

RF

Manifestations

Treatment

Answer 6

AIDS, endemic country

Long duration, ab pain/distension, f, night seats, wl, anorexia

anti-mycobacterial antibiotcs

Question 7

Malignant ascites usually from

Secondary implant into peritonuem

Tumor cells in peritoneum produce fluid

lymphatic obstruction leads to

Answer 7

Peritoneal carcinomatosis

Mucin-producing adenocarcinoma (stomach, colon, panc, bD), serous adenocarcinoma (ovarian)

protein rich fluid, draws EC fluid, high WBC

chylous ascites

Question 8

Peritoneal mesothelioma

Result of

Manifesations

Ascitic fluid

Answer 8

asbestos exposure

wl/crampy/girth out of proportion

hemorrhagic

Question 9

Hepatic ascites

Consequence of

Manifestations

Answer 9

portal HTN- fibrosis dirsupts sinusoids and normal BF through liver

inc girth, LEE, fluid wave, shifting dullness

Question 10

Cardiac ascites and hepatic fxn

SBP bacteria

MCC cause

Dx criteria

Answer 10

normal

K pneumo, S pneumo, E coli

cirrhosis

ascitic fluid PMN inc
Positive ascitic fluid culture
low ascitic fluid protein

Question 11

Mx of SBP

Answer 11

Cefotaxime/Abumin IV

Question 12

Secondary peritonitis

Bacteria origintate from

Disrupted normal defense mechs

Site of viscus disruption

Answer 12

Disrupted hollow vscus/penetrating injury

Intraperitoneal fluid dilutes opsonization, Hb allows E coli to generate leukotoxins

Proximal (sterile)- inflam/ infection later
Disal- bacterial, rapid sepsis

Question 13

RLQ

LLQ

Pelvis

Subphrenic region

Abscess site and cause

Answer 13

Appendicitis, perf ulcer

diverticulitis, IBD, CRC

Appendicitis, CR perf, gyne

PU, cholecystitis, pancreatitis

Question 14

Secondary peritonitis is

Bacterial flora of gastroduodenal area

distal SI

colon

Answer 14

polymicrobial

gram+

gram - and anaerobic

same

Question 15

Typical gram -

anaerobes

Answer 15

E coli, Kleb, Enterobacter, Proteus

Bacteroidies fragilis, Clostridium

Question 16

Clinical manifestations of secondary peritonitis

Surgical abdomen

systemic

Answer 16

worsening sx, pain w movement, guarding, diminshed bowel sounds

fever, tachycardia, tachypnea, shock

Question 17

Management

Preoperative resuscitation

Surgery

Answer 17

IV Fluids and AB
cef+metro/clinda
Amp/sul
Ticar/clav
Imipenem/cilastatin

Remove infected material
correct underlying cause

Question 18

Familal Mediterranean fever

Inheritance

Deficiency of

Population

Presentation

unique

Answer 18

AR

Protease that inactivates IL8 and complement 5A

Mediterranean- Sephardic Jews, Armenians, Turks, Arabs

Fever, ab pain, guarding, RT, meningitis, arthritis

recurrent, self limited peritonitis= resolves in 24-48 hrs