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A. MLA Map Paediatrics > Peritonitis > Flashcards

Peritonitis Flashcards

1
Q

What is peritonitis?

1 - inflammation of peri-anal area
2 - inflammation of the parenchyme of the liver
3 - inflammation of the peritoneum

A

3 - inflammation of the peritoneum

  • peritoneum is a membrane, a sheet of smooth tissue that lines your abdominopelvic cavity and surrounds your abdominal organs.
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2
Q

If a patient has peritonitis, but is correctly treated surgically, what is the mortality rate?

1 - 1%
2 - 5%
3 - 10%
4 - 35%

A

3 - 10%

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3
Q

If a patient has peritonitis, and they develop sepsis, what is the mortality rate?

1 - 1%
2 - 5%
3 - 10%
4 - 35%

A

4 - 35%

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4
Q

If a patient has spontaneous bacterial peritonitis, what is the mortality rate?

1 - 1-5%
2 - 5-10%
3 - 10-15%
4 - 35-40%

A

3 - 10-15%

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5
Q

If a patient has had peritonitis previously, what is the reoccurrence rate?

1 - 5%
2 - 10%
3 - 15%
4 - 70%

A

4 - 70%
- in one year

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6
Q

Peritonitis is an inflammation of the peritoneum, which is a membrane that lines the abdominopelvic cavity and wraps around some organs. How does it generally begin?

1 - local inflammation of abdominal viscus
2 - local inflammation of the omentum
3 - systemic inflammation of all viscera
4 - systemic inflammation of all mesenteries

A

1 - local inflammation of abdominal viscus

  • viscus is singular for visceral, which means internal organs of the cavities
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7
Q

In peritonitis is the initial pain well localised?

A
  • no
  • once parietal peritoneum is involved pain become localised to viscus affected
  • can become worse if abdominal muscles are engaged
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8
Q

Is peritonitis generally present in most GI diseases/conditions?

A
  • yes
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9
Q

If the local peritoneum is insufficient at containing the infection or local cause of peritonitis, what can happen?

1 - viscus affected can become ischaemic and die
2 - generalised peritonitis occurs
3 - all organs in the abdomen become affected
4 - patient will become septic

A

2 - generalised peritonitis occurs

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10
Q

What is an abscess?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

A

4 - pus filled collection lined by granulation tissue

  • generally contains dead tissue, neutrophils, exudate (high protein and LDH)
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11
Q

What is a cyst?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

A

1 - sac filled with fluid or other material lined by epithelial cells

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12
Q

What is an pseudocyst?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

A

2 - fluid filled area lined by granulation tissue

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13
Q

What is a fistula?

1 - opening lines by granulation tissues
2 - abnormal passageway, or tunnel, in the body, usually both lines by epithelial cells
3 - abnormal passageway, or tunnel, in the body, usually both lines by granulation tissue

A

2 - abnormal passageway, or tunnel, in the body, usually both lines by epithelial cells

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14
Q

What is a sinus?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - blind ended tract

A

4 - blind ended tract

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15
Q

What is an ascites?

1 - fluid filled abscess
2 - fluid filled cyst
3 - fluid filled space in the abdomen
4 - fluid filled organs

A

3 - fluid filled space in the abdomen

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16
Q

What is the most common cause of peritonitis?

1 - abscess
2 - cyst
3 - pseudocyst
4 - fistula

A

1 - abscess

  • can be due to omentum trying to wall off infection
  • various perforations (appendicitis, diverticulitis, gall bladder, GIT, malignancy or ischaemic bowel)
17
Q

Is generalised peritonitis, which is generally due to infection or chemical irritation due to leakage of bowel contents, dangerous?

A
  • yes
18
Q

Generalised peritonitis, which is generally due to infection or chemical irritation due to leakage of bowel contents is very dangerous and can lead to bacterial infection. Which 2 bacteria are the most common cause?

1 - E.coli and Klebsiella
2 - E.coli and Bacteroides
3 - Bacteroides and Klebsiella
4 - Streptococcus and E.coli

A

2 - E.coli and Bacteroides

19
Q

What is primary peritonitis

1 - inflammation of the whole peritoneum
2 - inflammation of peritoneum with no clear intra-abdominal source
3 - inflammation of greater omentum
4 - inflammation of visceral peritoneum

A

2 - inflammation of peritoneum with no clear intra-abdominal source

  • rare but generally due to infection of ascitic fluid in liver disease caused by streptococcus
20
Q

Which of the following are NOT a common symptom of peritonitis?

1 - anorexia
2 - fever
3 - severe generalised abdominal pain radiating to shoulders and back
4 - abdominal pain worse with movement
5 - coughing
6 - melena
7 - sneezing

A

6 - melena

21
Q

Which of the following is NOT a common sign of peritonitis?

1 - fever
2 - tachycardia
3 - increased BP
4 - generalised abdominal tenderness with guarding, rigidity, rebound tenderness
5 - swinging pyrexia

A

3 - increased BP

22
Q

If peritonitis moves from local to generalised peritonitis, does the patients condition get better or worse?

A
  • declines rapidly
23
Q

If a patient has secondary peritonitis, secondary due to perforation, which of the following is NOT a common sign?

1 - sudden onset of acute and severe abdominal pain
2 - gradual increase in pain and distention
3 - collapse of the patient
4 - patient goes into shock

A

2 - gradual increase in pain and distention

24
Q

If a patient has swinging pyrexia (moves between chills and fever) in suspected peritonitis, what can this suggest?

1 - abscess or pyogenic infection
2 - abscess or cyst
3 - pyogenic infection or cyst

A

1 - abscess or pyogenic infection

  • neutrophils are released but then destroyed
25
Q

Is secondary peritonitis as dangerous as primary peritonitis?

A
  • no
  • symptoms gradually become worse
26
Q

Peritonitis can cause pneumoperitoneum. What imaging modality is best to detect the presence of pneumoperitoneum?

1 - erect chest X-ray
2 - supine chest X-ray
3 - erect MRI scan
4 - erect CT scan

A

1 - erect chest X-ray

  • air will rise to the above the liver
27
Q

For a definitive diagnosis of peritonitis, what 2 imaging modalities are most commonly used?

1 - CT and MRI
2 - ultrasound and MRI
3 - ultrasound and X-ray
4 - CT and ultrasound

A

4 - CT and ultrasound

28
Q

When assessing for peritonitis we need to take bloods. Which of the following is NOT typically raised during peritonitis?

1 - Hb and WCC
2 - CRP
3 - U+Es
4 - amylase
5 - clotting factors
6 - LFTs
7 - bilirubin
8 - group and save (determines patient blood group)

A

7 - bilirubin

29
Q

If a patient has peritonitis and we suspect ischaemic bowel or pancreatitis, what blood test must we do?

1 - CRP
2 - WCC
3 - ABG
4 - neutrophils

A

3 - ABG

30
Q

If a patient has suspected bacterial peritonitis, what raised marker in blood is generally enough to begin treatment?

1 - RBCs
2 - neutrophils
3 - WCC
4 - leukocytes

A

2 - neutrophils

31
Q

If a patient has peritonitis and an abscess has been identified as the cause and is accessible on a CT or ultrasound, what treatment would the patient be given?

1 - ultrasound guided percutaneous drainage
2 - laparotomy and abscess drainage
3 - percutaneous drainage if palpable
4 - fluids and rest

A

1 - ultrasound guided percutaneous drainage

  • if unable to drain percutaneously then patient will need a laparotomy to drain the abscess and treat underlying cause
32
Q

In generalised peritonitis the patient is at risk of sepsis. Which of the following is NOT a treatment for patients who becomes septic?

1 - give IV fluid and put in catheter to monitor fluids
2 - prescribe antibiotics (metronidazole + cefuroxime)
3 - place patient on air and measure lactate levels
4 - take blood sample for blood cultures
5 - encourage the patient to eat for calories due to stress

A

5 - encourage the patient to eat for calories due to stress

  • patient may also be placed on an NG tube
33
Q

If a patient has generalised peritonitis and requires surgery via laparotomy, which of the following is NOT a treatment?

1 - partial dissection of pancreas as underlying cause
2 - peritoneal and abdominal cavity lavage
3 - treatment of underlying condition (appendicitis etc.)

A

1 - partial dissection of pancreas as underlying cause

34
Q

If a patient has generalised peritonitis and requires surgery for initial diagnosis, is laparotomy or laparoscopy preferred?

A
  • laparoscopy
  • minimises wound complications and more rapid recovery
35
Q

If a patient has suspected peritonitis following surgery and presents with swinging pyrexia, high WCC and continued pain) what should we suspect for?

1 - local abscess formation
2 - local ascities
3 - perforation
4 - local cyst formation

A

1 - local abscess formation

  • commonly pelvis or subphrenic

A. MLA Map Paediatrics (61 decks)

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