peritonitis

Question 1

List some substances that can cause irritation of the peritoneum

Answer 1

Blood
GI content eg faeces and bile
air
bacterial infection

Question 2

Is peritonitis a type of acute abdomen?

Answer 2

yes

Question 3

What is the prognosis of sb with peritonitis?

Answer 3

90-95% die if untreated

10-15% die if treated

Question 4

What is the classical presentation of pain in peritonitis?

Answer 4

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

Question 5

How does peritonitis due to intestinal obstruction present?

Answer 5

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

Question 6

Give one cause of bowel obstruction that can lead to peritonitis

Answer 6

adhesions

Question 7

Why does obstructed bowel lead to peritonitis?

Answer 7

the bowel loses its blood supply and stretches and then starts irritating the peritoneum
fluid containing bacteria can leak from the bowel

Question 8

What are the main clinical manifestations of peritonitis?

Answer 8

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

Question 9

what sign can we see on X-ray if there is a perforation?

Answer 9

can see air under the diaphragm

Question 10

What is a complication of a posterior perforation?

Answer 10

the arteries ie branches of the coeliac trunk can be affected and get a large GI bleed and blood clot formation

Question 11

List some causes of peritonitis

Answer 11

ectopic pregnancy
bowel obstruction
appendicitis - perforated
gastric/duodenal ulcer

Question 12

What is the best diagnostic test for peritonitis?

Answer 12

physical examination

Question 13

What is the dermatome of the foregut?

Answer 13

T5-9

Question 14

what is the dermatome of the midgut?

Answer 14

T8-11

Question 15

What is the dermatome of the hindgut?

Answer 15

T12-L3

Question 16

What other tests may be useful apart from physical examination in peritonitis?

Answer 16

X-ray

CT scan

Question 17

What is the P-POSSUM score?

Answer 17

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

Question 18

What are the changes that happen in the body in shock due to bacterial sepsis?

Answer 18

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

Question 19

What are the principles of treatment in peritonitis?

Answer 19

resuscitate - ABC
confirm diagnosis
operate
HDU if needed