Peritonitis Flashcards

1
Q

define peritonitis?

A

inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised.

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2
Q

what are the catagories of peritonitis?

A
  • localised
  • primary generalised
  • secondary generalised
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3
Q

what might cause localised peritonitis?

A

o Appendicitis
o Cholecystitis
o Diverticulitis
o Salpingitis

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4
Q

what is primary generalised peritonitis?

A

o Bacterial infection of the peritoneal cavity without an obvious source

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5
Q

what is Secondary Generalised Peritonitis?

A

Caused by bacterial translocation from a localised focus

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6
Q

epidemiology of peritonitis?

A
  • Primary peritonitis is RARE
  • Primary peritonitis is usually seen in adolescent females
  • Localised and secondary generalised peritonitis is COMMON in surgical patients
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7
Q

signs of localised peritonitis on examination?

A

o Tenderness on examination
o Guarding
o Rebound tenderness

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8
Q

signs of generalised peritonitis on examination?

A
o	Very unwell 
o	Systemic signs 
o	The patient will lie still 
o	Shallow breathing  
o	Rigid abdomen 
o	Generalised abdominal tenderness  
o	Reduced bowel sounds
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9
Q

what bloods should be done when suspecting peritontis?

A
o	FBC 
o	U&Es 
o	LFTs 
o	Amylase  
o	CRP  
o	Clotting  
o	Group & Save or Cross-match  
o	Blood cultures  
o	Pregnancy test  
o	ABG
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10
Q

what imaging should be undertaken when suspecting peritonitis?

A

o Erect CXR (check for air under the diaphragm)
o AXR (check for bowel obstruction)
o USS or CT abdomen
o Laparoscopy

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11
Q

what investigations should be used when ascites is present?

A

o Ascitic tap and cell count

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12
Q

how to manage localised peritonitis?

A

o Depends on CAUSE
o Some causes may require surgery (e.g. appendicitis)
o Some causes can be treated with antibiotics (e.g. salpingitis)

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13
Q

how to manage generalised peritonitis?

A
o	Laparotomy  
•	Remove the infected or necrotic tissue  
•	Treat cause  
•	Peritoneal lavage  
o	IV fluids  
o	IV antibiotics  
o	Urinary catheter  
o	NG tube  
o	Central venous line
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14
Q

how is primary generalised peritonitis managed?

A
  • treated by antibiotics
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15
Q

what are the features of spontaneous bacterial peritonitis?

A
  • seen by patients with ascites secondary to liver cirrhosis
  • caused by E.coli
  • o Paracentesis = neutrophils >250
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16
Q

how is SBP managed?

A

o IV cefotaxime given to manage

o Oral ciprofloxacin given prophylactically

17
Q

complications of peritonitis?

A
•	Early 
o	Septic shock  
o	Respiratory failure  
o	Multiorgan failure  
o	Paralytic ileus  
o	Wound infection  
o	Abscesses  
•	Late 
o	Incisional hernia  
o	Adhesions
18
Q

prognosis for localised peritonitis?

A

• Localised peritonitis usually resolves with treatment of the underlying cause

19
Q

prognosis for generalised peritonitis?

A

• Generalised peritonitis has a much higher mortality (30-50%)

20
Q

prognosis for primary peritonitis?

A

good prognosis with antibiotic treatment

21
Q

prognosis for SBP?

A

mortality > 30% if treatment is delayed