Peritonitis Flashcards
Which conditions increase your risk of SBP?
decompensated liver cirrhosis and end-stage liver disease
what is the most common cause of SBP?
E.coli
Which type of bacteria usually cause SBP?
gram-negative
what are the symptoms of peritonitis?
Vomiting/ nausea Fever/pyrexia Abdominal swelling Abdominal pain Diarrhoea or constipation Altered mental status Signs of sepsis eg. hypotension, tachycardia
What are the signs of peritonitis?
Flank dullness Shifting dullness Fluid wave/thrill Involuntary abdominal guarding Rebound tenderness Rigidity
What are the risk factors for SBP?
decompensated cirrhosis ascites GI bleeding Endoscopic scleropathy Low ascitic protein
Differentials for peritonitis?
SBP Secondary peritonitis Pancreatic peritonitis Tuberculous peritionitis Intra-peritoneal haemorrhage
What blood tests should be done for peritonitis?
FBC LFTs CRP Albumin Blood culture PTT/INR
what would you expect to see on an LFT in SBP?
Increased liver enzymes and bilirubin
what would you expect serum albumin levels to be in SBP?
low
what would you expect to see in haemorrhaging peritonitis on a PTT/INR
increased
What would you test for in peritonitis in a US-guided abdominal paracentesis?
Appearance Neutrophils LDH, glucose, protein Culture Carcinoembryonic antigen Alkaline phosphatase
Which would be your first choice antibiotics for community-acquired SBP?
cefotaxime or ceftriaxone
Which would be your first choice antibiotics for nosocomial-acquired SBP?
piperacillin/tazobactam or imipenem/cilastatin
what are the complications of SBP?
sepsis tense ascites renal failure bleeding after paracentesis bowel perforation after paracentesis leakage from the paracentesis puncture site
what does increased creatinine indicate in peritonitis?
hepatorenal syndrome
In secondary peritonitis, which ascitic fluid criteria would you expect at least 2 of to be satisfied?
Glucose <2.8mmol/L
Total ascitic protein >10g/L
LDH >225 U/L
which markers MAY be increased in secondary peritonitis?
carcinoembryonic antigen >5microgram/L
Alkaline phosphatase >240 U/L
What are the complications of secondary peritonitis?
enterocutaneous fistula
Surgical site infection
Sepsis
Multiorgan failure
how would you test for tuberculous peritonitis?
tuberculin skin testing sputum smear/culture Lymph node fine-needle aspiration Peritoneal biopsy Nucleic acid amplification test (NAAT)
what would you expect to find in a peritoneal biopsy in tuberculous peritonitis?
caseating granulomas and acid-fast bacilli
what would you expect to find in ascitic fluid analysis in tuberculous peritonitis?
exudate
low SAAG unless cirrhotic
Adenosine deaminase levels elevated
Elevated free interferon-gamma levels - positive for mycobacterium tuberculosis
Which combinations of drugs for tuberculous peritonitis would you use in the acute phase?
Isoniazid
Rifampicin
Ethambutol
Pyrazinamide IF NOT pregnant
how long do you give tuberculosis medication for in the acute phase?
8 weeks
