Peritonitis

Question 1

What is peritonitis?

Answer 1

Peritonitis = inflammation of the peritoneum (the serosal membrane lining the abdominal cavity), typically caused by bacterial infection (either via blood or abdominal organ rupture)

Question 2

What is the aetiology of peritonitis?

Answer 2

Typically caused by a bacterial infection
o Sepsis

Abdominal organ rupture – pathogens involved differ in proximal/distal GI tract

Peptic/duodenal ulcer perforation
Diverticulitis
Appendicitis
Bowel perforation
Cholecystitis
Also trauma/malignancy/iatrogenic

Question 3

What are the risk factors for peritonitis?

Answer 3

Ascites - Liver disease, Alcoholism
Peritoneal dialysis
Surgical procedure

Question 4

What is the epidemiology of peritonitis?

Answer 4

Both children and adults, of both genders

Question 5

What are the symptoms of peritonitis?

Answer 5

Abdominal pain/discomfort
o Initially dull/poorly localised then progressing to steady/severe/more localised pain
o Exacerbated by any movement and local pressure

Chills

Diarrhoea

Question 6

What are the signs of peritonitis?

Answer 6

• Fever (80%)
• Absent bowel sounds
• Board-like abdominal rigidty
• Prostration
• Shock
• Lying still
• Abdominal tenderness and guarding
• Positive cough test
• Ascites
• Abdominal distention
• Tachycardia

Question 7

What are the investigations for peritonitis?

Answer 7

Bloods
o	FBC: leukocytosis 
o	CRP
o	Hypokalaemia, hypernatremia
o	Serum amylase, alkaline phosphatase

CXR
o Free air under diaphragm

Urinalysis
Stool

AXR
o Bowel dilation

Peritoneal fluid analysis

CT
Diagnostic laparoscopy

Question 8

What is the management for peritonitis?

Answer 8

Surgical referral
o NBM
o Exploration and lavage

Analgesia
IV fluids
IV ABs
Oxygen
NG tube
Urinary catheter

Question 9

What are the possible complications of peritonitis

Answer 9

• Surgical complications
• Anaesthetic complications
• Peritonitis complications

o Enterocutaneous fistula
o Abdominal compartment syndrome - Related to acutely increased abdominal pressure

Question 10

What is the prognosis of peritonitis?

Answer 10

Reduction in mortality and morbidity due to better AB therapy, more aggressive intensive care and earlier diagnosis

Almost always fatal if untreated

IF severe, mortality can increase to 30-50%

Poor outcome predictors: old age, malnutrition, cancer, preoperative organ dysfunction

Surgical cases have mortality rate around 10%