Peritonitis Flashcards
How can you differentiate between peritonitis and renal colic?
Peritonitis features pain when coughing and moving.
Renal colic features pain when staying still, relieved by moving. “Cannot sit still”
Name 3 clinic symptoms of peritonitis?
Anorexia
Pyrexia
Several generalised abdominal pain, radiating to shoulders and back
Pain worse with movement, coughing, sneezing
What scenario may feature peritonitis with apyrexia?
Patients taking corticosteroids
How can the causes of peritonitis be grouped?
Primary (rare)
Secondary (common)
Name 3 clinical signs of peritonitis
Pyrexia
Tachycardia
Peritonism: Tenderness and guarding, Rebound tenderness
Localised pain during distant palpation (Rovsing’s sign)
What is the most likely cause of primary peritonitis?
Streptococcal infection via blood stream.
Rare, usually occurs in immunocompromised patients.
List 4 common causes of secondary peritonitis
Acute perforated appendicitis Acute perforated diverticular disease Upper GI perforation Perforated tumour (colonic or gastric) Perforated ischaemic bowel Acute pancreatitis Peritoneal dialysis Post-surgical intervention
What is the commonest cause of secondary peritonitis in under 45s?
Acute perforated appendicitis
What is the commonest cause of secondary peritonitis in elderly?
Acute perforated diverticular disease
How is a perforation diagnosis confirmed?
Laparotomy - surgical incision to examine abdominal organs
What is acute peritonitis?
Acute inflammation of the peritoneal cavity
Name 3 features that suggest a perforated viscus
Sudden onset of pain Constant severe pain Pain aggravated by movement, coughing, sneezing Diffuse tenderness Silent rigid abdomen
What investigation may be raised in perforated bowel?
Serum amylase - suggestive of pancreatitis
What laboratory investigations may be done in acute peritonitis?
FBC U&E CRP Amylase - pancreatitis ABG - if shocked or pancreatitis suspected
What is the investigation of choice for diagnosing acute peritonitis?
Abdominal CT
Excludes acute pancreatitis, and often locates the probable source of pathology.