Peritonitis Flashcards
What is peritonitis?
Inflammation of the peritoneum
What is the peritoneum?
Thin delicate layer of cells that covers the external surfaces of all abdominal and pelvic organs
What are the causes of peritonitis?
=> Occurs as peritoneum is damaged by bacterial infection. Routes bacteria can take to infect peritoneum:
- From the exterior
- From abdominal viscera
- Post operative leak
- From the blood stream as part of septicemia
- From the female genital tract
- From perforation
Why is untreated bacterial peritonitis dangerous?
Can lead to sepsis, septic shock and death
What is the treatment of localised or minimal generalised peritonitis following sterile abdominal surgery?
- Resolves spontaneously
What are the clinical features of peritonitis?
- Pyrexia
- Tachycardia
- Constant abdominal pain
- Abdominal tenderness and guarding
- Rebound tenderness (pain or discomfort when removing hand from affected area)
- Localised pain during distal palpation
- Absence of bowel sounds
=> As peritonitis progresses, patient gets progressively worse
What are the investigations in suspected peritonitis?
=> Full Blood Count
- Marked leucocytosis
=> Serum amylase
- In cases of acute pancreatitis
=> Erect chest radiograph
- Free gas under diaphragm
=> CT
- Pinpoints exact cause of peritonitis
What is the management of peritonitis?
- IV fluid and electrolyte replacement
- Antibiotic therapy
- Pain relief
- Gastric aspiration
- Surgery indicated if the source of the peritonitis can be removed or closed
What is Spontaneous Bacterial Peritonitis?
Form of peritonitis seen in people with ascites secondary to liver cirrhosis
What are the clinical features of Spontaneous Bacteria Peritonitis?
- Ascites
- Abdominal pain
- Fever
What is the investigation for suspected Spontaneous Bacterial Peritonitis?
=> Paracentesis
Neutrophil count > 250 cells/ul
E.Coli is the most common organism found is ascitic fluid
What is the management of Spontaneous Bacterial Peritonitis?
IV Cefotaxime
When should antibiotic prophylaxis be given to those with Ascites?
- Patients who have had an episode of SBP
- Patients with fluid protein < 15 g/l + (Child-Pugh ≥ 9 or hepatorenal syndrome)
=> Prophylactic antibiotic used: Oral Ciprofloxacin or Norfloxacin
