Peritonitis Flashcards

1
Q

Define Peritonitis

A

Inflammation of the peritoneum

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2
Q

What are different ways to classify peritonitis

A

Based on onset (acute or chronic)
Source of origin (Primary or Secondary)
Cause (Bacterial or chemical)
Location (localised or generalised)

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3
Q

Causes of peritonitis

A
  • 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
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4
Q

Epidemiology of peritonitis

A

Extremely rare
<1% adults
2% children

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5
Q

Risk groups of peritonitis

A
Liver disease (SBP)
Females
Immune compromised (post-splenectomy)
Peritoneal dialysis patient
Ascites
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6
Q

What is SBP

A

Spontaneous Bacterial Peritonitis

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7
Q

Presentation of acute peritonitis (most peritonitis)

A

Pain - site, nature, progress
Tenderness - localised (progression to generalised)
Systemic symptoms - nausea, chills and rigor, dizziness, weakness and inability to move due to pain

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8
Q

Clinical presentation of peritonitis

A

Pyrexia, tachycardia, confusion (encephalopathy)
Hypotension, hypoxia (late signs of shock)
Abdomen examination:
-Guarding, rebound, rigidity
-Silent abdomen (ominous sign)

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9
Q

How to differentiate generalised and localised peritonitis

A

Patients lie still
Localised = avoid strain on part affected
Generalised = lie very still

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10
Q

Diagnosis of peritonitis

A

Blood tests - FBC, U/Es, Amylase, LFTs
Plain X-ray (chest - erect perforation; abdomen - supine)
CT scan abdomen
*Ascites lactate level >25mg/dL

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11
Q

How would you define SBP

A

Absolute neutrophil count>250 cells/mm^3

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12
Q

Treatment of peritonitis

A

Resuscitate (e.g. SBP)
-ABC prinicple (airway breathing circulation) + antibiotics
Treat the cause:
Medical (only for primary peritonitis) or surgical

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13
Q

Examples of primary peritonitis

A

SBP
Pelvic inflammatory disease
PD related peritonitis

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14
Q

Surgical treatment of peritonitis

A

Repair of perforated viscus - peptic ulcer

Excision of perforated organ (with or without drainage/restoring continuity)

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