peritonitis

Question 1

what is secondary peritonitis?

Answer 1

Secondary peritonitis is an inflammatory condition of the peritoneum, usually resulting from the spillage of gastrointestinal or biliary contents into the peritoneal cavity

Question 2

what can cause secondary peritonitis?

Answer 2

perforated peptic ulcer, ruptured appendicitis, diverticulitis, and gastrointestinal tract perforations secondary to trauma or neoplasia.

Question 3

pathophysiology of peritonitis?

Answer 3

The pathogenesis of secondary peritonitis revolves around the breach of the gastrointestinal tract’s integrity, leading to contamination of the sterile peritoneal environment. This contamination initiates an inflammatory response, characterised by the activation of the innate immune system, recruitment of neutrophils, and release of pro-inflammatory cytokines. The severity of peritonitis depends on the nature and amount of the contaminating material, as well as the host’s immune response.

Question 4

presentation of peritonitis?

Answer 4

Patients with secondary peritonitis typically present with acute abdominal pain, which is often severe and localised to the site of the underlying pathology. The pain may become more diffuse as the inflammation spreads across the peritoneum. Other common symptoms include fever, tachycardia, and signs of peritoneal irritation such as rebound tenderness and guarding.

Systemic inflammatory response syndrome (SIRS) may develop in severe cases, potentially progressing to septic shock.

Question 5

dx of peritonitis?

Answer 5

Diagnosis is primarily clinical, supported by imaging and laboratory investigations. Abdominal radiographs may show evidence of pneumoperitoneum in cases of gastrointestinal perforation. Ultrasonography and computed tomography (CT) scans are more sensitive in detecting intra-abdominal abscesses and delineating the extent of inflammation. Laboratory investigations typically reveal leukocytosis and elevated inflammatory markers such as C-reactive protein (CRP).

Question 6

mx of peritonitis?

Answer 6

surgical ix
broad spec abx

Question 7

what is spontaneous bacterial peritonitis?

Answer 7

Spontaneous bacterial peritonitis (SBP) is a form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.

Question 8

features of SBP?

Answer 8

ascites
abdominal pain
fever

Question 9

dx of SBP?

Answer 9

paracentesis: neutrophil count > 250 cells/ul
the most common organism found on ascitic fluid culture is E. coli

Question 10

mx of SBP?

Answer 10

intravenous cefotaxime is usually givenw

Question 11

when is prophylaxis is given for SBP?

Answer 11

patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

Question 12

what is a marker of poor prognosis in SBP?

Answer 12

Alcoholic liver disease