Peritoneal Disorders

Question 1

Bile Ascites

Answer 1

Comp of biliary surgery or liver biopsy or abdominal trauama

Can be sterile

Ascites bilirubin to serum bilirubin>1

Question 2

Malignant ascites

Answer 2

2/3 are peritoneal carcinomatosis…mucin producing or serous pap

Tumor cells secrete protein rich fluid with lots of lymphos

Question 3

SBP organisms and mg

Answer 3

E.coli
K.pneumoniae
S.oneumo

Alsom, a low ascitic fluid protein increases risk of SBP

Cefotaxime and albumin

Question 4

Secondary peritonitis

Answer 4

Disrupts normal defense mechs by diluting opsonic proteins and allowing E coli to generate leukotoxins

Proximal are sterile
Distal are heavility bact

Question 5

RLQ
LLQ
Pelvis
Subprhenic

Answer 5

Appen, ulcer

Divert, IBD, CRC

Append, perfor, gyne

Ulcer, chole, panc

Question 6

Micro of secondary perit

Answer 6

Gram neg - E.coli, klen, enterobacter, proteus

Anaerobic - bacteroides, clostridium

ABs…ceftriaxone and metro to tx

Question 7

CM of secondary peritnoitis

Answer 7

Acute abdomen with worsening sx in the absence of surgery

AB pain worse with movement

Guarding

Oliguira with potential shock

Question 8

Familai mediterranean fever

Answer 8

Def of protease that inactivates IL8 and complement 5A

Recurrent attacks of peritonitis that resolve in 24-48 hours