Peritonitis Flashcards
What is peritonitis?
Inflammation of the peritoneum.
What is the difference between primary and secondary peritonitis?
Primary is inflammation of the peritoneum itself e.g. spontaneous bacterial peritonitis; Secondary is inflammation as a result of an adjacent pathological process e.g. perforation.
What is localised and systemic peritonitis?
Localised is limited to one area of the peritoneum e.g. prior to rupture; systemic is widespread inflammation e.g. after rupture.
What are the causes of peritonitis? (x9)
o Perforation of peptic/duodenal ulcer, diverticulum, appendix, bowel or gallbladder.
o Spontaneous bacterial peritonitis.
o Systemic infections such as TB.
o Disruption of the peritoneum may also cause infection simply by letting microorganisms into the peritoneal cavity: trauma and surgery.
o Malignancy
o Cholecystitis
o Pancreatitis
o Endocarditis
What are the risk factors for peritonitis? (x3)
Liver disease, ascites, alcoholism.
What are the symptoms of peritonitis? (x5)
o Acute abdominal pain: initially insidious (gradually growing), dull and poorly localised. Becomes more localised as the infection spreads.
o Fever
o N&V
o Anorexia
o SOB
What are the signs of peritonitis? (x8)
o Abdominal tenderness +/- rebound pain (Blumberg’s sign) OR percussion pain.
o Guarding
o Board-like abdominal rigidity – stiffness in muscles that worsens on touch
o Prostration (exhaustion)
o Shock
o Laying still
o Positive cough test – patient coughs and asked if they are in pain or show signs of pain
o Tachycardia
o Ileus paralyticus (intestinal paralysis) – no bowel sounds (this leads to N&V).
What are the complications of peritonitis? (x3)
o Sequestration of fluid and electrolytes may cause electrolyte imbalances and shock from hypovolaemia.
o Peritoneal abscess
o Sepsis
What are the investigations for peritonitis? (x5)
o BLOODS: increased WCC, low potassium, high sodium, acidosis. Cultures as a complication is sepsis.
o AXR: dilated, oedematous intestines
o CXR: may show gas under the diaphragm
o Diagnostic laparotomy in cases of doubt
o In patients with ascites, paracentesis (abdominal tap) is performed and WCCC counted along with Gram staining to identify microorganism and assess antimicrobial sensitivity.
How is peritonitis treated? (x3)
o IV fluids and correction of electrolyte imbalance
o Antibiotics – broad-spectrum
o Laparotomy to lavage (wash out) the peritoneum and correct gross anatomical damage that may have caused the peritonitis.
What is the prognosis of peritonitis?
Mortality rate less than 10% in surgically correctable peritonitis e.g. perforated ulcer, appendicitis, diverticulitis. Rate rises to 40% in the elderly, those that present late, or have underlying illness.
What condition also causes these symptoms? Therefore, what else must you always do in investigations?
Pancreatitis has the same signs so must also measure amylase levels.
What is spontaneous bacterial peritonitis, SBP?
Development of a bacterial infection in the peritoneum causing peritonitis, despite the absence of an obvious infective source.
What common organisms are involved in SBP?
E. coli, Klebsiella and streps.
What are the causes of SBP? (x2)
Occurs mostly in portal hypertension patients from CIRRHOSIS of the liver. Can also be from NEPHROTIC SYNDROME.
