peritonitis Flashcards
List some substances that can cause irritation of the peritoneum
Blood
GI content eg faeces and bile
air
bacterial infection
Is peritonitis a type of acute abdomen?
yes
What is the prognosis of sb with peritonitis?
90-95% die if untreated
10-15% die if treated
What is the classical presentation of pain in peritonitis?
vague abdominal pain in the dermatome of the foregut, midgut or hindgut due to irritation of the visceral peritoneum layer and so irritation of the autonomic NS. then the pain becomes very localised to one area due to irritation of the somatic nerves in the parietal peritoneum
How does peritonitis due to intestinal obstruction present?
general colicky pain over umbilicus initially
then more localised pain
vomit contains bile and so looks green
peritonism only if bowel is threatened - ie guarding, abdominal muscle tensing, pain worse on movement
Give one cause of bowel obstruction that can lead to peritonitis
adhesions
Why does obstructed bowel lead to peritonitis?
the bowel loses its blood supply and stretches and then starts irritating the peritoneum
fluid containing bacteria can leak from the bowel
What are the main clinical manifestations of peritonitis?
acute abdominal pain
abdominal tenderness
abdominal guarding
pain exacerbated by movement, coughing, flexing the hips, rebound tenderness
rigidity - is a very specific physical exam finding
what sign can we see on X-ray if there is a perforation?
can see air under the diaphragm
What is a complication of a posterior perforation?
the arteries ie branches of the coeliac trunk can be affected and get a large GI bleed and blood clot formation
List some causes of peritonitis
ectopic pregnancy
bowel obstruction
appendicitis - perforated
gastric/duodenal ulcer
What is the best diagnostic test for peritonitis?
physical examination
What is the dermatome of the foregut?
T5-9
what is the dermatome of the midgut?
T8-11
What is the dermatome of the hindgut?
T12-L3
What other tests may be useful apart from physical examination in peritonitis?
X-ray
CT scan
What is the P-POSSUM score?
It is an online scoring system that can be completed by surgeons pre-op to find out the percentage risk morbidity and mortality from operating
What are the changes that happen in the body in shock due to bacterial sepsis?
get massive vasodilation from the release of bacterial toxin
this causes peripheral resistance to decrease
the heart rate has to increase to maintain BP
the heart can’t keep up so blood is diverted to the kidneys brain and heart and diverted away from the gut
What are the principles of treatment in peritonitis?
resuscitate - ABC
confirm diagnosis
operate
HDU if needed
