Peritonitis Flashcards
Define
inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised.
Causes
Localised Peritonitis
- Appendicitis
- Cholecystitis
- Diverticulitis
- Salpingitis
Primary Generalised Peritonitis
- Bacterial infection of the peritoneal cavity without an obvious source
- Could be via haematogenous or lymphatic spread or ascending infection from the female genital tract)
Risk Factors
- Ascites
- Nephrotic syndrome
Secondary Generalised Peritonitis
- Caused by bacterial translocation from a localised focus
- Could be non-bacterial due to spillage of bowel contents, bile and blood (e.g. perforated peptic ulcer)
Epidemiology
Primary peritonitis is RARE
Primary peritonitis is usually seen in adolescent females
Localised and secondary generalised peritonitis is COMMON in surgical patients
Symptoms
•Fatigue •Oliguria •SOB •Tachycardia •Dizziness
Signs
Check vital signs and look for signs of dehydration or compromised perfusion (e.g. due to sepsis or hypovolaemia)
Localised Peritonitis
- Tenderness on examination
- Guarding
- Rebound tenderness
Generalised Peritonitis
- Very unwell
- Systemic signs of toxaemia or sepsis (e.g. fever, tachycardia)
- The patient will lie still
- Shallow breathing
- Rigid abdomen
- Generalised abdominal tenderness
- Reduced bowel sounds (may be absent due to paralytic ileus)
- DRE may show anterior tenderness (suggests pelvic peritonitis)
Investigations
Bloods
- FBC
- U&Es
- LFTs
- Amylase
- CRP
- Clotting
- Group & Save or Cross-match
- Blood cultures
- Pregnancy test
- ABG
Imaging
- Erect CXR (check for air under the diaphragm)
- AXR (check for bowel obstruction)
- USS or CT abdomen
- Laparoscopy
If Ascites
- Ascitic tap and cell count
- SBP = > 250 neutrophils/mm3
- Gram stain and culture
Management
Localised Peritonitis
- Depends on CAUSE
- Some causes may require surgery (e.g. appendicitis)
- Some causes can be treated with antibiotics (e.g. salpingitis)
Generalised Peritonitis
- Patient may be at risk of DEATH from sepsis or shock
- IV fluids
- IV antibiotics
- Urinary catheter
- NG tube
- Central venous line (to monitor fluid balance)
- Laparotomy
- Remove the infected or necrotic tissue
- Treat cause
- Peritoneal lavage
- Primary Peritonitis - should be treated with antibiotics
Spontaneous Bacterial Peritonitis (SBP)
Quinolone antibiotics
OR
Cefuroxime + Metronidazole
Complications
Early
- Septic shock
- Respiratory failure
- Multiorgan failure
- Paralytic ileus
- Wound infection
- Abscesses
Late
- Incisional hernia
- Adhesions
Prognosis
- Localised peritonitis usually resolves with treatment of the underlying cause
- Generalised peritonitis has a much higher mortality (30-50%)
- Primary peritonitis has a good prognosis with antibiotic treatment
- SBP has a mortality > 30% if diagnosis and treatment is delayed
