Peritonitis Flashcards
What is peritonitis?
inflammation of peritoneum
Localised (prior to rupture) or generalised (after rupture)
Most commonly caused by gastrointestinal perforation
List 4 localised forms of peritonitis
Appendicitis
Cholecystitis
Diverticulitis
Salpingitis
What is Primary Generalised Peritonitis? What is this AKA?
Spontaneous Bacterial Peritonitis
Ascitic fluid infection w/o an evident intra-abdominal surgically treatable source
What is Secondary Generalised Peritonitis?
Bacterial translocation from adjacent organs or due to perforation
Summarise the epidemiology of peritonitis
Primary = RARE
Localised + secondary generalised = COMMON in surgical patients
Give 4 symptoms of peritonitis
Acute severe abdo pain
Exacerbated by movement + coughing
N+V
Fever
Why may symptoms be vague in those with liver disease and ascites?
Due to confusion caused by encephalopathy
Describe the pain in localised peritonitis
Initially: dull + poorly localised (due to inflammation of visceral peritoneum)
Becomes severe, sharp + localised as parietal peritoneum becomes involved
List 7 signs of peritonitis
Tenderness on palpation
Guarding
Rigidity
Fever
Tachycardia
Absent/ reduced bowel sounds
Features of septic shock: hypotension, oliguria, confusion
What is the difference between guarding and rebound tenderness?
Guarding: voluntary contraction of abdo muscles (to protect from pain)
Rigidity: involuntary muscle contraction due to underlying inflammation
What imaging is firstline in suspected peritonitis?
CT
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
What are the appropriate blood investigations for peritonitis?
FBC: High WCC
U+Es
LFTs: Raised ALP + BR, Low albumin
Amylase: r/o Pancreatitis
CRP: Inflammation
Clotting
X-match
Blood cultures: Sepsis
Pregnancy test
ABG
What older imaging may you perform in suspected peritonitis?
Erect CXR (air under diaphragm in perf)
AXR (for bowel obstruction)
USS (evidence of cirrhosis)
Describe the management of localised peritonitis
Depends on CAUSE
May require surgery (e.g. appendicitis)
May be treated with 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
Treat cause
Peritoneal lavage
List 6 early complications of peritonitis
Septic shock
Respiratory failure
Multiorgan failure
Paralytic ileus
Wound infection
Abscesses
List 2 late complications of peritonitis
Incisional trauma
Adhesions
What is the prognosis in peritonitis?
Localised: usually resolves with tx of underlying cause
Generalised: much higher mortality (30-50%)
Primary peritonitis has a good prognosis with abx tx
SBP has a mortality > 30% if dx + tx is delayed
Give a risk factors for SBP
Ascites secondary to Cirrhosis
What drugs are used to treat spontaneous bacterial peritonitis?
Cefotaxime IV
What is the most common causative organism of SBP?
E. coli
Name a marker of poor prognosis in SBP
Alcoholic liver disease
Which patients with ascites should be given antibiotic prophylaxis?
If have had an episode of SBP
If fluid protein <15g/l + either Child-Pugh score >9 OR hepatorenal syndrome
What antibiotics are used for prophylaxis of SBP?
Ciprofloxacin PO
Norfloxacin PO
