Peritonitis Flashcards
Define Peritonitis
Inflammation of the peritoneum
What are different ways to classify peritonitis
Based on onset (acute or chronic)
Source of origin (Primary or Secondary)
Cause (Bacterial or chemical)
Location (localised or generalised)
Causes of peritonitis
- Perforation of hollow viscus
- > Contamination of cavity with secretions, organism, e.g. peptic ulcer, colonic diverticulum, appendix, bladder
- Inflammation of abdominal organs -> Appendix, pancreas, small bowel, colon, gall bladder
- Peritoneal dialysis patient
- Tuberculosis
- Ischaemia hollow viscus
- Chemical - contamination
Epidemiology of peritonitis
Extremely rare
<1% adults
2% children
Risk groups of peritonitis
Liver disease (SBP) Females Immune compromised (post-splenectomy) Peritoneal dialysis patient Ascites
What is SBP
Spontaneous Bacterial Peritonitis
Presentation of acute peritonitis (most peritonitis)
Pain - site, nature, progress
Tenderness - localised (progression to generalised)
Systemic symptoms - nausea, chills and rigor, dizziness, weakness and inability to move due to pain
Clinical presentation of peritonitis
Pyrexia, tachycardia, confusion (encephalopathy)
Hypotension, hypoxia (late signs of shock)
Abdomen examination:
-Guarding, rebound, rigidity
-Silent abdomen (ominous sign)
How to differentiate generalised and localised peritonitis
Patients lie still
Localised = avoid strain on part affected
Generalised = lie very still
Diagnosis of peritonitis
Blood tests - FBC, U/Es, Amylase, LFTs
Plain X-ray (chest - erect perforation; abdomen - supine)
CT scan abdomen
*Ascites lactate level >25mg/dL
How would you define SBP
Absolute neutrophil count>250 cells/mm^3
Treatment of peritonitis
Resuscitate (e.g. SBP)
-ABC prinicple (airway breathing circulation) + antibiotics
Treat the cause:
Medical (only for primary peritonitis) or surgical
Examples of primary peritonitis
SBP
Pelvic inflammatory disease
PD related peritonitis
Surgical treatment of peritonitis
Repair of perforated viscus - peptic ulcer
Excision of perforated organ (with or without drainage/restoring continuity)