Peritonitis Flashcards
Define:
inflammation of the peritoneal cavity. can be localised or generalised.
Aetiology/risk factors:
Localised (common in surgery patients)
- Diverticulitis
- Appendicitis
- Cholecystitis
- Salpingitis (fallopian tube inflammtion)
Primary generalised (rare but common in adolescent girls) -Bacterial infection (haematogenous or from female genital tract)
Secondary generalised (common in surgical patients)
- bacterial translocation
- spillage of bowel contents into the peritoneum (perforated peptic ulcer or bowel obstruction)
Symptoms:
Continuous, sharp and localised pain
Exacerbated by movement
Symptoms are difficult in those with chronic liver disease due to the encephalopathy leading to confusion.
Signs - localised and generalised separately:
Look for signs of dehydration and sepsis e.g. hypovolemia
Localised:
- Rebound tenderness
- Guarding
Generalised:
- Abdo tenderness
- Reduced or absent bowel sounds
- very unwell
- signs of sepsis
- patient lies still
- shallow breaths
- rigid abdomen
Investigations:
FBC U+E's LFT Pregnancy test ABG Blood cultures Clotting Amylase (rule out pancreatitis) CRP
CXR - air under the diaphragm suggests perforation
AXR - look for bowel obstruction
USS
CT
Laparoscopy
Ascitic tap - SBP if >250 neutrophils/mm3
management:
similar to that of bowel obstruction (drip and suck) for generalised:
- IV fluids
- IV antibiotics
- NG tube
- Urinary catheter
- Central venous line
- Laproscopy to remove infected or necrotic tissue
Localised:
-Treat the cause either using antibiotics or surgery
SBP:
Quinolone antibiotics or Cefuroxime + metronidazole
complications:
early:
- septic shock
- respiratory or multi-organ failure
- paralytic ileus
- wound infection
- abscesses
late:
- incision hernia
- adhesions
Prognosis:
localised usually resolves with treatment
SBP mortality >30% in those with delay in treatment
Generalised mortality 30-40%
Primary generalised has a good prognosis
