Peritonitis

Question 1

What can peritonitis act as a local inflammatory cause for?

Answer 1

Ascites

Question 2

Define peritonitis

Answer 2

Inflammation of the peritoneum (Often due to infection)

Question 3

What are the main causes of peritonitis?

Answer 3

1) Non-infective: Bile leak, Blood ruptured from an ectopic pregnancy
2) Infective: Perforated organ bacterial infection, spontaneous bacterial peritonitis, bacterial infection secondary to peritoneal dialysis

Question 4

What is the most common cause of bacterial infection from those with cirrhosis?

Answer 4

Spontaneous Bacterial Peritonitis

Affects the immunocompromised and those undergoing peritonitis

Question 5

What are the common bacteria found in spontaneous bacterial peritonitis?

Answer 5

1) E. Coli

2) S. Pneumoniae

Question 6

How is SPB diagnosed and what are the main S/S?

Answer 6

Presence of neutrophils in ascitic fluid

S/S: Pain, Tenderness, Systemic infection

Question 7

What are 3 symptoms of SPB?

Answer 7

Abdominal pain, temperature, dull percussion

Question 8

What are the main complications of SPB?

Answer 8

1) Kidney Failure
2) Hypovolaemia
3) Systemic sepsis
4) Paralytic Ileus
5) Pulmonary atelectasis (Lung Collapse)
6) Portal Pyaemia (Pus in portal vein)

Question 9

What are the main investigations for peritonitis?

Answer 9

1) B Test: Platelet, WCC, CRP, amylase
2) CXR: Look for air under diaphragm
3) Abdominal X-Ray: Bowel obstruction
4) CT: Inflammation, ischaemia and cancer
5) ECG: Epigastric pain related to the heart
6) B-hCG: Hormone secreted by pregnant women

Question 10

How can paralytic ileus can lead to respiratory problems?

Answer 10

Peristaltic waves stop
Dilation of bowel –> Distended abdomen –> Increase of Pa
Pushes on diaphragm so respiration is affected

Question 11

What is the management for peritonitis?

Answer 11

1) ABC
2) Treat underlying cause
3) Call a surgeon
4) Set up post-management support