Peritonitis Flashcards
What is peritonitis?
inflammation of peritoneum
Localised (prior to rupture) or generalised (after rupture)
List 4 localised forms of peritonitis
Appendicitis
Cholecystitis
Diverticulitis
Salpingitis
What is Primary Generalised Peritonitis? What is this AKA?
Spontaneous BP
Inflammation of peritoneum itself
NO obvious source
Haematogenous/ lymphatic spread or ascending infection
What is Secondary Generalised Peritonitis?
Bacterial translocation from adjacent organs or due to perforation
Summarise the epidemiology of peritonitis
Primary = RARE: often adolescent females
Localised + secondary generalised = COMMON in surgical patients
Describe the symptoms of peritonitis
Peritoneal pain: continuous, sharp, localised
Exacerbated by movement + coughing
Sx may be vague in those with liver disease + ascites (due to confusion caused by encephalopathy)
List 2 signs of localised peritonitis on physical examination
Guarding
Rebound tenderness
What are the appropriate blood investigations for peritonitis?
FBC: High WCC Metabolic panel Amylase: exclude Pancreatitis CRP + ESR raised Clotting X-match Blood cultures: Sepsis Pregnancy test ABG
What additional investigations may you perform in suspected peritonitis?
Erect CXR (air under diaphragm in perf) AXR (for bowel obstruction) USS (evidence of cirrhosis)
What is the best diagnostic investigation to perform if there is ascites in peritonitis?
Paracentesis (Ascitic tap) + cell count
SBP = > 250 neutrophils/mm3
Gram stain + culture
Describe the management of localised peritonitis
Depends on CAUSE
Surgery (e.g. appendicitis)
Abx (e.g. salpingitis)
Describe the management of generalised peritonitis
IV fluids IV abx Urinary catheter NG tube Central venous line (to monitor fluid balance) Laparotomy Remove infected or necrotic tissue Peritoneal lavage
4 complications of peritonitis
Septic shock (+/-death)
Respiratory failure
Kidney failure
Hepatic failure
What is the prognosis in peritonitis?
Localised: usually resolves with tx of underlying cause
Generalised: higher mortality (30-50%)
Primary peritonitis has a good prognosis with abx tx
SBP has a mortality > 30% if dx + tx is delayed
List 6 signs of generalised peritonitis
Systemic signs of sepsis (e.g. fever, tachycardia)
Shallow breathing
Pt lies still with a rigid abdomen
Generalised abdo tenderness
Reduced bowel sounds (absent if paralytic ileus)
DRE may show anterior tenderness (suggests pelvic peritonitis)
