Peritonitis

Question 1

What is the first step in the management of acute abdomen?

Answer 1

ABCDE Assessment (if stable proceed)

ABCDE stands for Airway, Breathing, Circulation, Disability, Exposure.

Question 2

List common symptoms of peritonitis.

Answer 2

• Fever, chills
• Tachycardia
• Absent bowel sounds if obstructed
• Anorexia, N/V, diarrhoea, hypovolaemia, renal failure
• Ascites, abdominal distention, abdominal rigidity
• Encephalopathy, delirium, confusion, cognitive decline

N/V stands for nausea and vomiting.

Question 3

Which laboratory tests are used in the assessment of peritonitis?

Answer 3

• FBC
• CMP - Comprehensive Metabolic Panel
• LFT - Liver Function Test
• Leukocytes and neutrophils
• Lactate
• Lipase
• Amylase

Question 4

What imaging is recommended for evaluating peritonitis?

Answer 4

Abdominal and Pelvic CT

Question 5

What is the use of a diagnostic paracentesis?

Answer 5

Used to evaluate and measure serum-ascites albumin gradient (SAAG)used to grade peritonitis.

Question 6

What does a serum-ascites albumin gradient (SAAG) of less than 1.1 indicate?

Answer 6

Direct cause of primary peritonitis

It suggests conditions such as peritoneal dialysis dysfunction/infection, peritoneal carcinomatosis, or peritoneal endometriosis.

Question 7

What are the characteristics of spontaneous bacterial peritonitis (SBP)?

Answer 7

• Ascites
• Abdominal pain
• Fever

SBP is often seen in patients with ascites secondary to liver cirrhosis.

Question 8

How is spontaneous bacterial peritonitis diagnosed?

Answer 8

Paracentesis: neutrophil count > 250 cells/ul

Paracentesis is a procedure to remove fluid from the abdominal cavity.

Question 9

What is the most common organism found in ascitic fluid culture for SBP?

Answer 9

E. coli

Escherichia coli is a common bacterium that can cause infections.

Question 10

What is the first-line management for spontaneous bacterial peritonitis?

Answer 10

Intravenous cefotaxime

Cefotaxime is a third-generation cephalosporin antibiotic.

Question 11

When should antibiotic prophylaxis be given to patients with ascites?

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

The Child-Pugh score assesses the prognosis of chronic liver disease.

Question 12

Which antibiotics does NICE recommend for prophylaxis in patients with cirrhosis and ascites?

Answer 12

• Prophylactic oral ciprofloxacin
• Norfloxacin

These antibiotics are recommended until the ascites has resolved.

Question 13

What is a poor prognosis marker in spontaneous bacterial peritonitis?

Answer 13

Alcoholic liver disease

Patients with alcoholic liver disease may have worse outcomes in SBP.

Question 14

What type of peritonitis is characterized by post-operative inflammatory processes?

Answer 14

Tertiary Peritonitis

Tertiary peritonitis occurs when there are no new signs of infections.

Question 15

What are the common treatments for peritonitis?

Answer 15

• Systemic Antibiotics
• IV fluids
• Pain management
• Oxygen (if required)
• Blood transfusion (if required)

Treatment may also include surgery for organ repair or abscess drainage.

Question 16

What differentiates secondary peritonitis from primary peritonitis?

Answer 16

Secondary peritonitis is due to bacterial seeding from a perforation or transmural infection of the bowel wall

It often presents with intra-abdominal free fluid, abscess, and bowel wall thickening on CT.