Peritonitis Flashcards
1
Q
Peritonitis Types
A
Primary
- Inflammation in peritoneum itself rather than from another organ
- Spontaneous bacterial peritonitis is when ascites secondary to end-stage liver disease becomes infected
Secondary
-Pathological process adjacent causes inflammation e.g. perforated viscus
Localised
-e.g. appendicitis
Generalised
-Widespread e.g. after perforation of viscus
Intra-abdominal sepsis
-Any intra-abdominal infection, encompasses localised and generalised
Abscesses
-Localised collections of infected fluid
2
Q
Peritonitis Aetiology
A
- Wide number of causes (most due to perforation)
- Upper GI: malignancy, trauma, ulcer perforation
- Lower GI: ischaemic bowel, diverticulitis, hernia, obstruction
- Liver/biliary/pancreas/spleen/kidneys: cholecystitis, malignancy, pancreatitis
- Genitourinary: PID
3
Q
Peritonitis Presentation
A
Abscess
- Symptoms are highly variable
- Fever, pain, diarrhoea, ileus
- Swinging pyrexia
- Palpable, hot, tender mass
Peritonitis
- Abdominal pain
- Insidious, dull and poorly localised, becomes gradually worse
- Sometimes acute pain from outset e.g. perforation
- Anxiety, N/V, usually lying still (unlike colic where usually moving around)
- Unwell, distressed, fever
- If severe may progress to hypothermia
- Tenderness, guarding, rebound tenderness
- Patient may lie with knees flexed to minimus movement of abdominal wall
4
Q
Peritonitis Ix
A
- FBC (leukocytosis)
- U&Es (dehydration)
- LFTs, amylase and lipase if pancreatitis suspected
- Blood cultures
- Peritoneal fluid (culture and amylase)
- Urinalysis (to exclude renal tract pathology)
- Imaging
5
Q
Peritonitis Management
A
Abscess
- Parenteral antibiotics based on results of culture (blood or abscess)
- Broad spectrum
- Surgery
- Percutaneous drainage under CT
Peritonitis
- For SBP cephalosporin, further guided by culture
- In secondary peritonitis; systemic antibxs
- Supportive therapy
- Surgery
