Peritonitis Flashcards

1
Q

what is peritonitis?

A

Inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein

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2
Q

what are the pathological effects of peritonitis?

A

o Widespread absorption of toxins from the large, inflamed surface
o The associated paralytic ileus with the following:
o Gross abdominal distension with the elevation of the diaphragm = lung collapse and pneumonia

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3
Q

what are the different types of peritonitis?

A

primary
secondary
tertiary

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4
Q

what are the causes of primary peritonitis?

A

hematogenous dissemination, immunocompromised patient e.g. SBP in liver disease

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5
Q

what are the causes of secondary peritonitis?

A

pathology in visceral organ, as perforation, trauma e.g. surgical peritonitis

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6
Q

what are the causes of tertiary peritonitis?

A

persistent or recurrent infection after adequate initial therapy

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7
Q

what are the causes of peritonitis?

A

• Introduction of infection through organ perforation
• Other irritants
o Foreign bodies
o Bile (perforated gall bladder/lacerated liver)
o Gastric acid (perforated ulcer)
o Blood

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8
Q

what are the common gram negative organisms associated with peritonitis?

A

Escherichia coli, Enterobacter/klebsiella, proteus, pseudomonas

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9
Q

what are the common gram positive organisms associated with peritonitis?

A

streptococci, enterococci, staphylococci

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10
Q

what are the common anaerobic organisms associated with peritonitis?

A

Bacteroides, eubacteria, clostridia, pepitosteptococci, peptococci,

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11
Q

what are the common fungal organisms associated with peritonitis?

A

candida

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12
Q

what are the different sources of secondary peritionitis?

A
oesophagus
stomach
duodenum
biliary tract
pancreas
small bowel
large bowel and appendix 
uterus, salpinx and ovaries
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13
Q

through which processes can the oesophagus cause peritonitis?

A

Boerhaave syndrome, malignancy, trauma (penetrating), iatrogenic

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14
Q

through which processes can the stomach cause peritonitis?

A

peptic ulcer perforation, malignancy (e.g. adenocarcinoma, lymphoma, GI stromal tumour), trauma (penetrating), iatrogenic

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15
Q

through which processes can the duodenum cause peritonitis?

A

peptic ulcer perforation, trauma (blunt + penetrating), iatrogenic

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16
Q

through which processes can the biliary tract cause peritonitis?

A

cholecystitis, stone perforation from gallbladder (i.e. gallstone ileus) or common duct, malignancy, choledochal cyst (rare), trauma (mostly penetrating), iatrogenic

17
Q

through which processes can the pancreas cause peritonitis?

A

pancreatitis (e.g. alcohol, drugs, gallstones), trauma (blunt + penetrating), iatrogenic

18
Q

through which processes can the small bowel cause peritonitis?

A

ischemic bowel, incarcerated hernia (internal + external), closed loop obstruction, Crohn’s disease, malignancy (rare), Meckel diverticulum, trauma (mostly penetrating)

19
Q

through which processes can the large bowel and appendix cause peritonitis?

A

ischaemic bowel, diverticulitis, malignancy, ulcerative colitis and Crohn’s disease, appendicitis, colonic volvulus, trauma (mostly penetrating), iatrogenic

20
Q

through which processes can the cause Uterus, salpinx and ovaries peritonitis?

A

PID (e.g. salpingo-oophorititis, tubo-ovarian abscess, ovarian cyst), malignancy (rare), trauma (uncommon)

21
Q

what are SOCRATEs features of pain in peritonitis?

A

o Site - Local (at site of organ source), or generalised
o Onset: acute
o Character: sharp
o Radiation
o Associated symptoms: all fever, vomiting, ileus, diarrhoea, jaundice, tachycardia
o Exacerbating by any movement: car/ambulance trip to the hospital (speedbumps)
o Severity: very severe

22
Q

what are the examination features of peritonitis?

A
o	Tender
o	Rebound tenderness
o	Guarding
o	Rigid
o	Distended 
o	Localized peritonitis (localized tenderness and rebound)
generalized peritonitis (generalized tenderness, guarding and rigidity= washboard) 
o	Abdomen silent?
23
Q

what are the clinical features of advanced peritonitis?

A

Distension of abdomen, tympanic abdo, rapid feeble pulse, faecal vomiting, eyes sunken, skin moist, cold and cyanosed

24
Q

what bloods are useful in peritonitis?

A

FBC, LFTS, Amylase, U&Es

25
what will an ABG in peritonitis show?
acidosis and high lactate
26
what bedside tests are useful in peritonitis?
Bladder scan, Urine dip, pregnancy test
27
what imaging methods are useful in peritonitis diagnosis?
``` CXR AXR CT Scan US MRI ```
28
what features may be present in in an CXR in peritonitis?
air under diaphragm, lower lobe pneumonia, rib fractures
29
what features may be present in in an AXR in peritonitis?
closed loop obstruction, SBO and LBO, air between bowel
30
what is thh first choice imaging method in peritonitis?
CT
31
when is US used in peritonitis?
in pregnant and young females
32
what is the management of peritonitis?
ABCDE Sepsis 6 Non-operative Operative
33
What are the non-operative management options for peritonitis?
o Percutaneous abscess drainage (intervention radiology) o Endoscopic stent placement (e.g. ERCP) o Gastric Aspiration
34
What are the operative management options for peritonitis?
o Control the infection source (remove the inflamed appendix, repair perforated gastric ulcer) o Clean the bacteria and toxins (washout)