Peritonitis

Question 1

What is peritonitis?

Answer 1

inflammation of peritoneal lining of abdo cavity

Question 2

What are two types of peritonitis?

Answer 2

localised to one part, or generalised

Question 3

What are examples of localised peritonitis?

Answer 3

1. Appendicitis
2. Cholecystitis
3. Diverticulitis
4. Salpingitis

Question 4

What are the two types of generalised peritonitis?

Answer 4

1. primary

2. secondary

Question 5

What is primary generalised peritonitis?

Answer 5

bacterial infection, without obvious source

Question 6

What are RF for primary generalised peritonitis?

Answer 6

1. cirrhosis
2. ascites
3. nephrotic syndrome

Question 7

What is the epid for primary generalised peritonitis?

Answer 7

RARE – seen in younger, F pts

Question 8

What are the common causative agents for primary generalised peritonitis?

Answer 8

1. E. coli and gram -ve bacteria generally

2. Staph aureus – particularly in post-operative cases

Question 9

What is secondary generalised peritonitis?

Answer 9

bacteria from pre-existing abdo condition

Question 10

What are the causes of secondary generslised peritonitis?

Answer 10

spillage of bowel content, bile and blood (perforated peptic ulcer, diverticulitis, cholecystitis, appendicitis)

Question 11

What are symptoms of peritonitis?

Answer 11

1. Pain
2. Reduced bowel sounds: paralytic ileus
3. Washboard rigidity
4. Guarding
5. Rebound tenderness
6. N+V
7. Signs of septic shock

Question 12

What are signs of septic shock?

Answer 12

1. hypotension
2. low GCS
3. N+V
4. cold and clammy
5. pale
6. dehydration signs

Question 13

What is washboard rigidity?

Answer 13

completely still

Question 14

What is paralytic ileus?

Answer 14

obstruction of the intestine due to paralysis of the intestinal muscles

Question 15

What bloods are done for perotinits?

Answer 15

1. Blood cultures (infection)
2. High WCC
3. High CRP

Question 16

What other investigations are done and results for peritonitis?

Answer 16

• If ascites: ascitic tap (neutrophils>250 if SBP)

- Erect CXR: air under diaphragm

Question 17

What other imaging can be done?

Answer 17

USS and CT abdo as imaging

Question 18

What is spontaneous bacterial peritonitis?

Answer 18

an infection of abdominal fluid, called ascites, that does not come from an obvious place within the abdomen, such as a hole in the intestines or a collection of pus

Question 19

What is the conservative management of periontitis?

Answer 19

1. IV fluids
2. IV ABx
3. NG tube

Question 20

How do you treat localised/secondary generalised peritonitis?

Answer 20

treat the cause, may require surgery (appendectomy) or simply ABx

Question 21

How do you treat primary generslised/sepsis?

Answer 21

broad spectrum ABx

Question 22

How do you treat infected/necrotic tissue in peritonitis?

Answer 22

1. necresectomy

2. peritoneal lavage

Question 23

What are possible peritonitis complications?

Answer 23

1. Septic shock
2. Respiratory failure
3. Multiorgan failure
4. Paralytic ileus
5. Wound infection
6. Abscesses
7. Adhesions

Question 24

What is the prognosis for peritonitis?

Answer 24

1. localised usually resolves after treating underlying cause
2. generalised peritonitis has a much higher mortality
3. SBP has a mortality > 30% if diagnosis and treatment is delayed

Question 25

What is the pain like in peritonitis?

Answer 25

1. Sudden onset
2. Sharp
3. Worse on movement
4. generalised to localised