Peritonitis Flashcards
What is peritonitis?
1 - inflammation of peri-anal area
2 - inflammation of the parenchyme of the liver
3 - inflammation of the peritoneum
3 - inflammation of the peritoneum
- peritoneum is a membrane, a sheet of smooth tissue that lines your abdominopelvic cavity and surrounds your abdominal organs.
If a patient has peritonitis, but is correctly treated surgically, what is the mortality rate?
1 - 1%
2 - 5%
3 - 10%
4 - 35%
3 - 10%
If a patient has peritonitis, and they develop sepsis, what is the mortality rate?
1 - 1%
2 - 5%
3 - 10%
4 - 35%
4 - 35%
If a patient has spontaneous bacterial peritonitis, what is the mortality rate?
1 - 1-5%
2 - 5-10%
3 - 10-15%
4 - 35-40%
3 - 10-15%
If a patient has had peritonitis previously, what is the reoccurrence rate?
1 - 5%
2 - 10%
3 - 15%
4 - 70%
4 - 70%
- in one year
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
1 - local inflammation of abdominal viscus
- viscus is singular for visceral, which means internal organs of the cavities
In peritonitis is the initial pain well localised?
- no
- once parietal peritoneum is involved pain become localised to viscus affected
- can become worse if abdominal muscles are engaged
Is peritonitis generally present in most GI diseases/conditions?
- yes
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
2 - generalised peritonitis occurs
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
4 - pus filled collection lined by granulation tissue
- generally contains dead tissue, neutrophils, exudate (high protein and LDH)
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
1 - sac filled with fluid or other material lined by epithelial cells
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
2 - fluid filled area lined by granulation tissue
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
2 - abnormal passageway, or tunnel, in the body, usually both lines by epithelial cells
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
4 - blind ended tract
What is an ascites?
1 - fluid filled abscess
2 - fluid filled cyst
3 - fluid filled space in the abdomen
4 - fluid filled organs
3 - fluid filled space in the abdomen
What is the most common cause of peritonitis?
1 - abscess
2 - cyst
3 - pseudocyst
4 - fistula
1 - abscess
- can be due to omentum trying to wall off infection
- various perforations (appendicitis, diverticulitis, gall bladder, GIT, malignancy or ischaemic bowel)
Is generalised peritonitis, which is generally due to infection or chemical irritation due to leakage of bowel contents, dangerous?
- yes
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
2 - E.coli and Bacteroides
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
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
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
6 - melena
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
3 - increased BP
If peritonitis moves from local to generalised peritonitis, does the patients condition get better or worse?
- declines rapidly
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
2 - gradual increase in pain and distention
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
1 - abscess or pyogenic infection
- neutrophils are released but then destroyed
Is secondary peritonitis as dangerous as primary peritonitis?
- no
- symptoms gradually become worse
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
1 - erect chest X-ray
- air will rise to the above the liver
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
4 - CT and ultrasound
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)
7 - bilirubin
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
3 - ABG
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
2 - neutrophils
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
1 - ultrasound guided percutaneous drainage
- if unable to drain percutaneously then patient will need a laparotomy to drain the abscess and treat underlying cause
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
5 - encourage the patient to eat for calories due to stress
- patient may also be placed on an NG tube
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.)
1 - partial dissection of pancreas as underlying cause
If a patient has generalised peritonitis and requires surgery for initial diagnosis, is laparotomy or laparoscopy preferred?
- laparoscopy
- minimises wound complications and more rapid recovery
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
1 - local abscess formation
- commonly pelvis or subphrenic
