Peritonitis Flashcards

1
Q

How can you differentiate between peritonitis and renal colic?

A

Peritonitis features pain when coughing and moving.

Renal colic features pain when staying still, relieved by moving. “Cannot sit still”

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2
Q

Name 3 clinic symptoms of peritonitis?

A

Anorexia
Pyrexia
Several generalised abdominal pain, radiating to shoulders and back
Pain worse with movement, coughing, sneezing

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3
Q

What scenario may feature peritonitis with apyrexia?

A

Patients taking corticosteroids

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4
Q

How can the causes of peritonitis be grouped?

A

Primary (rare)

Secondary (common)

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5
Q

Name 3 clinical signs of peritonitis

A

Pyrexia
Tachycardia
Peritonism: Tenderness and guarding, Rebound tenderness
Localised pain during distant palpation (Rovsing’s sign)

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6
Q

What is the most likely cause of primary peritonitis?

A

Streptococcal infection via blood stream.

Rare, usually occurs in immunocompromised patients.

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7
Q

List 4 common causes of secondary peritonitis

A
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
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8
Q

What is the commonest cause of secondary peritonitis in under 45s?

A

Acute perforated appendicitis

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9
Q

What is the commonest cause of secondary peritonitis in elderly?

A

Acute perforated diverticular disease

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10
Q

How is a perforation diagnosis confirmed?

A

Laparotomy - surgical incision to examine abdominal organs

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11
Q

What is acute peritonitis?

A

Acute inflammation of the peritoneal cavity

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12
Q

Name 3 features that suggest a perforated viscus

A
Sudden onset of pain
Constant severe pain
Pain aggravated by movement, coughing, sneezing
Diffuse tenderness
Silent rigid abdomen
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13
Q

What investigation may be raised in perforated bowel?

A

Serum amylase - suggestive of pancreatitis

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14
Q

What laboratory investigations may be done in acute peritonitis?

A
FBC
U&E
CRP
Amylase - pancreatitis
ABG - if shocked or pancreatitis suspected
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15
Q

What is the investigation of choice for diagnosing acute peritonitis?

A

Abdominal CT

Excludes acute pancreatitis, and often locates the probable source of pathology.

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16
Q

Outline the early treatment of acute peritonitis

A

IV antibiotics when diagnosis is unclear. Especially useful if surgery is likely.

Analgesia
Correct fluid balance
Monitor

17
Q

Outline the definitive management of acute peritonitis

A

Management depends on the cause of peritonitis.

18
Q

Differentiate between local and generalised peritonitis

A

Local: peritonism over a single area
General: peritonism over entire abdomen with board-like rigidity

Generalised peritonitis is also more likely to have signs of:

  • Ileus (distension, vomiting, tympanic abdomen with reduced/absent bowel sounds)
  • Systemic shock (tachycardia, tachypnoea, hypotension, low urine output).
19
Q

What is the management of generalised peritonitis?

A
*Surgical emergency*
IV fluid resuscitation
IV ABX
Laparotomy/Laparoscopy - peritoneal wash-out and treatment of underlying condition
Monitor for post-op complications
20
Q

What are the causes of generalised peritonitis?

A
Bacterial infection - faecal matter from diverticulitis
Progression from localised inflammatory peritonitis
Leakage of body fluids
-Gastric juice
-Bile
-Urine
-Pancreatic juice
-Blood

*Body fluids are initially sterile but become infected with 24-48hr of leaking.

21
Q

In what scenario can a CT abdomen be considered in generalised peritonitis?

A

If it can be performed urgently and the patient is stable.

*Does not change management

22
Q

Name 3 bedside tests useful for diagnosing local peritonitis

A

Rebound tenderness
Cough test
Hip flexion test

23
Q

What would indicate the development of a peritoneal abscess?

A

Swinging fever
Swelling
Raised WCC
Increasing or sustained pain

24
Q

How is a peritoneal abscess managed?

A

Percutaneous drainage or laparotomy

25
Q

What investigations should be done in generalised peritonitis?

A

CT abdomen - if quick and patient is stable

Serum amylase - to exclude pancreatitis

26
Q

What is the complication of delaying treatment of generalised peritonitis?

A

Further toxaemia, septicaemia, and multi organ-failure

27
Q

What initial radiological test should be performed for suspected perforation? What sign is evident?

A

Erect CXR to look for pneumoperitoneum

AXR would show Rigler sign (double wall)