Peritonitis

Question 1

Define peritonitis

& spread

Answer 1

Inflammation of the peritoneal lining of the abdominal cavity

Can be localised to 1 part of the peritoneum or generalised

Question 2

Classification of peritonitis

3 or 2

Answer 2

Localised peritonitis
Primary generalised peritonitis
Secondary generalised peritonitis

Spontaneous bacterial peritonitis
Secondary peritonitis

Question 3

Aetiology of peritonitis - localised

4

Answer 3

Appendicitis
Cholecystitis
Diverticulitis
Salpingitis

Question 4

Aetiology of peritonitis - primary

2 + 2 risk factors

Answer 4

Bacterial infection of the peritoneal cavity without an obvious source
Could be via haematogenous/lymphatic spread or ascending infection (from female genital tract)

Risk factors -
Ascites
Nephrotic syndrome

Question 5

Aetiology of peritonitis - secondary

2

Answer 5

Caused by bacterial translocation from localised focus

Could be non-bacterial due to spillage of bowel contents, bile & blood

Question 6

Epidemiology of peritonitis - primary

prevalence & population group

Answer 6

RARE

Usually seen in adolescent females

Question 7

Epidemiology of peritonitis - localised & generalised

population group

Answer 7

COMMON in surgical patients

Question 8

Presenting symptoms of peritonitis

2

Answer 8

Inflammation of parietal peritoneum is usually continuous, sharp, localised & exacerbated by movement & coughing
Symptoms can be vague in those w/ liver disease & ascites

Question 9

Signs of peritonitis on physical examination - localised

general check, 3

Answer 9

Check vital signs & look for signs of dehydration or compromised perfusion

Tenderness on examination
Guarding
Rebound tenderness

Question 10

Signs of peritonitis on physical examination - generalised

8

Answer 10

Very unwell
Systemic signs of toxaemia or sepsis 
Lying still
Shallow breathing
Rigid abdomen
Generalised abdominal tenderness
Reduced bowel sounds
DRE may show anterior tenderness

Question 11

Investigations for peritonitis

3 types

Answer 11

Bloods
Imaging
Ascites considerations

Question 12

Investigations for peritonitis - bloods

10

Answer 12

FBC
U&Es
LFTs
Amylase
CRP
Clotting
Group & save or Cross-match
Blood cultures
Pregnancy test
ABG

Question 13

Investigations for peritonitis - imaging

4

Answer 13

Erect CXR - check air under diaphragm
AXR - check bowel obstruction
USS or CT abdo
Laparoscopy

Question 14

Investigations for peritonitis - if ascites

2 + SBP defintion

Answer 14

Ascitic tap & cell count
Gram stain & culture

SBP = >250 neutrophils/mm^3

Question 15

Management of peritonitis - localised

2

Answer 15

Depends on cause

Some may require surgery others can be treated w/ antibiotics

Question 16

Management of peritonitis - generalised

7 + primary

Answer 16

Patient may be at risk of DEATH from sepsis or shock
IV fluids 
IV antibiotics 
Urinary catheter
NG tube
Central venous line
Laparotomy

Primary should be treated w/ antibiotics

Question 17

Management of peritonitis - SBP

1 or 2

Answer 17

Quinolone antibiotics
OR
Cefuroxime + Metronidazole

Question 18

Complications of peritonitis - early

6

Answer 18

Septic shock 
Respiratory failure
Multi organ failure
Paralytic ileus
Wound infection
Abscesses

Question 19

Complications of peritonitis - late

2

Answer 19

Incisional hernia

Adhesions

Question 20

Prognosis of peritonitis

4 types

Answer 20

Localised peritonitis usually resolves w/ treatment of underlying cause
Generalised peritonitis has much higher mortality (30-50%)
Primary peritonitis has good prognosis w/ antibiotic treatment
SBP has mortality >30% if diagnosis & treatment delayed