Peritonitis Flashcards
define peritonitis?
inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised.
what are the catagories of peritonitis?
- localised
- primary generalised
- secondary generalised
what might cause localised peritonitis?
o Appendicitis
o Cholecystitis
o Diverticulitis
o Salpingitis
what is primary generalised peritonitis?
o Bacterial infection of the peritoneal cavity without an obvious source
what is Secondary Generalised Peritonitis?
Caused by bacterial translocation from a localised focus
epidemiology of peritonitis?
- Primary peritonitis is RARE
- Primary peritonitis is usually seen in adolescent females
- Localised and secondary generalised peritonitis is COMMON in surgical patients
signs of localised peritonitis on examination?
o Tenderness on examination
o Guarding
o Rebound tenderness
signs of generalised peritonitis on examination?
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
what bloods should be done when suspecting peritontis?
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
what imaging should be undertaken when suspecting peritonitis?
o Erect CXR (check for air under the diaphragm)
o AXR (check for bowel obstruction)
o USS or CT abdomen
o Laparoscopy
what investigations should be used when ascites is present?
o Ascitic tap and cell count
how to manage localised peritonitis?
o Depends on CAUSE
o Some causes may require surgery (e.g. appendicitis)
o Some causes can be treated with antibiotics (e.g. salpingitis)
how to manage generalised peritonitis?
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
how is primary generalised peritonitis managed?
- treated by antibiotics
what are the features of spontaneous bacterial peritonitis?
- seen by patients with ascites secondary to liver cirrhosis
- caused by E.coli
- o Paracentesis = neutrophils >250