Peritonitis Flashcards
What is peritonitis?
Inflammation of the peritoneum - usually caused by inflammation of a viscus underneath
Results in inflammation of the visceral peritoneum (causing generalised abdo pain) then may progress to inflammation of the parietal peritoneum (localised abdo pain)
Describe how the innervation of the peritoneum effects how pain is felt.
Parietal - somatic innervation as of the region of the abdominal wall it overlies - well localised
Visceral - autonomic innervation as of viscera inside - poorly localised - causes generalised abdominal pain
Describe where referred pain is felt for each forgut, midgut, hindgut
Forgut - epigastric region - T4-T9 dermatome
Midgut - umbilical region T10-T12 dermatome
Hindgut - suprapubic region - L1,2,3
What are the different sections of the peritoneum?
Parietal - lines the abdominal wall.
Visceral - covers the viscera
Peritoneal cavity - potential space between these layers normally contains only a small amount of lubricating fluid
What cavity does ascitic fluid build up in?
The peritoneal cavity
What is localised peritonitis?
Symptom of abdo pain and tenderness
Occurs with all acute inflammatory condition of the GI system - treatment is treatment of the underlying disease
What is generalised peritonitis?
‘peritonitic’
Often a result of abdominala organ rupture resulting in chemical irritation due to leakage of intestinal rupture, or from infection (aka perforated appendicitis)
Sudden onset of abdo pain which becomes generalised/all over
The patient is acutely unwell. Inflammatory exudate spreads across the peritoneal cavity, leading to intestinal dilation and paralytic ileus.
How does the peritonitic patient present?
Nausea and vomiting
Anorexia
*Board like abdomen and guarding
Abd distention and rigidity
*Rebound tenderness
Decreased bowel sounds
Signs of systemic illness -tachycardia, Hypotensive, fever
Dehydrated
*Severe pain made worse with motion
*Look unwell from the end of the bed
How would peritonitis be diagnosed by investigations?
X-ray - chronic may show peritoneal thickening, enhancement and fluid look for sign of perforation
Elevated WBC
Peritoneal fluid (ascitis fluid) analysis - elevated wbcs (defined at neutrophil count above 250cells/mm3), culture, leukocyte esterase reagent strip
What is the treatment for peritonitis?**
Identify cause
Adminster antibiotics
IV fluids - electrolyte balance
Decrease abdominal distention
What are the different types of guarding? in reference to pain
- Voluntary - conscious contraction of the abdominal wall in anticipation of an exam that will cause pain
- Involuntary guarding - reflex contraction or spasm of the abdominal muscles on palpation due to peritoneal inflammation.
What is spontaneous bacterial peritonitis?
Almost seen only in patients with liver cirrhosis
Bacterial infection of ascitic fluid (within the peritoneal cavity)
It should be suspected in all patients with liver cirrhosis who present with - acute abdo pain, fever, and systemically unwell.
How can you differentiate between localised and generalised peritonitis by patient presentation?
Generalised - often perforation, sudden attack with acute, severe abdominal pain, followed by general collapse and shock. May improve temporarily then deterioriates due to tozaemia.
Localised - less rapid, initial symptoms of underlying disease.
What are some common differential diagnoses for peritonitis?
AAA
Pancreatitis/appendicitis/ bowel obstruction
UTI
Whipple disease (bacterial infection of the small intestine)
What is the epidemiology of peritonitis?
Secondary peritonitis is around 1% of emergency hospital admission
Primary peritonitis is very uncommon amongst adults with no risk factors.
