Peritonitis

Question 1

def

Answer 1

inflammation of peritoneal lining of abdominal cavity

localised or generalised

Question 2

is generalised peritonitis primary or secondary

Answer 2

both

Question 3

aetiology of localised

Answer 3

1 appendicitis
2 cholecystitis
3 diverticulitis

Question 4

aetiology of primary generalised

Answer 4

bacterial infection of peritoneal cavity
1 spontaneous bacterial peritonitis
2 renal failure patients with CPAD

Question 5

what is spontaneous bacterial peritonitis associated with

Answer 5

cirrhosis

ascites

Question 6

what is CPAD

Answer 6

continuous ambulatory peritoneal dialysis

Question 7

aetiology of secondary generalised

Answer 7

usually spreads from other source of infection

e.g. perforated peptic ulcer, pancreatic secretions

Question 8

epi

Answer 8

localised and secondary generalised are common

primary generalised is rare (adolescent females)

Question 9

history

Answer 9

1 parietal pain

• continuous
• sharp
• exacerbated by movement or coughing

Question 10

examination of localised

Answer 10

1 tenderness with involuntary guarding

2 rebound tenderness

Question 11

examination of generalised

Answer 11

1 patient very unwell, systemic signs (fever, tachycardia)
2 movement exacerbates pain
3 generalised guarding and rebound tenderness

Question 12

what would you expect to hear from the bowel sounds in generalised peritonitis

Answer 12

reduced or absent (paralytic ileus)

Question 13

investigations

Answer 13

1 bloods
2 erect CXR for pneumoperitoneum
3 AXR for bowel obstruction
4 CT abdomen/laparoscopy
-to diagnose cause of peritonitis

Question 14

what is pneumoperitoneum

Answer 14

abnormal presence of air in peritoneal cavity

Question 15

what would be looked for in bloods

Answer 15

• FBC
• UEs
• LFTs
• amylase (exclude pancreatitis)
• CRP (for inflammation)

Question 16

what happens to the greater omentum in peritonitis

Answer 16

sticks to inflamed organ to prevent spread

Question 17

how would ascites be investigated and what could it diagnose

Answer 17

1 ascitic tap and cell count

2 SBP >250neutrophils/mm3

Question 18

management of localised

Answer 18

dependent on cause:
appendicectomy in appendicitis
IV antibiotics in cholecystitis, diverticulitis)

Question 19

management of generalised

Answer 19

IV fluids, electrolytes, antibiotics to protect against sepsis + shock
monitor fluid balance
surgical intervention

Question 20

when would an urgent laparotomy be performed

Answer 20

identify + treat cause

remove infected or necrotic tissue

Question 21

management of primary peritonitis

Answer 21

antibiotics

Question 22

complications

Answer 22

1 septic shock
2 multi-organ failure
3 paralytic ileus

Question 23

prognosis

Answer 23

localised peritonitis usually resolves with treatment

generalised peritonitis has high mortality rate (higher with sepsis + multi-organ failure)