Peritonitis Flashcards
What is peritonitis?
inflammation of peritoneal lining of abdo cavity
What are two types of peritonitis?
localised to one part, or generalised
What are examples of localised peritonitis?
- Appendicitis
- Cholecystitis
- Diverticulitis
- Salpingitis
What are the two types of generalised peritonitis?
- primary
2. secondary
What is primary generalised peritonitis?
bacterial infection, without obvious source
What are RF for primary generalised peritonitis?
- cirrhosis
- ascites
- nephrotic syndrome
What is the epid for primary generalised peritonitis?
RARE – seen in younger, F pts
What are the common causative agents for primary generalised peritonitis?
- E. coli and gram -ve bacteria generally
2. Staph aureus – particularly in post-operative cases
What is secondary generalised peritonitis?
bacteria from pre-existing abdo condition
What are the causes of secondary generslised peritonitis?
spillage of bowel content, bile and blood (perforated peptic ulcer, diverticulitis, cholecystitis, appendicitis)
What are symptoms of peritonitis?
- Pain
- Reduced bowel sounds: paralytic ileus
- Washboard rigidity
- Guarding
- Rebound tenderness
- N+V
- Signs of septic shock
What are signs of septic shock?
- hypotension
- low GCS
- N+V
- cold and clammy
- pale
- dehydration signs
What is washboard rigidity?
completely still
What is paralytic ileus?
obstruction of the intestine due to paralysis of the intestinal muscles
What bloods are done for perotinits?
- Blood cultures (infection)
- High WCC
- High CRP
What other investigations are done and results for peritonitis?
- If ascites: ascitic tap (neutrophils>250 if SBP)
- Erect CXR: air under diaphragm
What other imaging can be done?
USS and CT abdo as imaging
What is spontaneous bacterial peritonitis?
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
What is the conservative management of periontitis?
- IV fluids
- IV ABx
- NG tube
How do you treat localised/secondary generalised peritonitis?
treat the cause, may require surgery (appendectomy) or simply ABx
How do you treat primary generslised/sepsis?
broad spectrum ABx
How do you treat infected/necrotic tissue in peritonitis?
- necresectomy
2. peritoneal lavage
What are possible peritonitis complications?
- Septic shock
- Respiratory failure
- Multiorgan failure
- Paralytic ileus
- Wound infection
- Abscesses
- Adhesions
What is the prognosis for peritonitis?
- localised usually resolves after treating underlying cause
- generalised peritonitis has a much higher mortality
- SBP has a mortality > 30% if diagnosis and treatment is delayed
What is the pain like in peritonitis?
- Sudden onset
- Sharp
- Worse on movement
- generalised to localised
