Peritonitis

Question 1

Define Peritonitis

Answer 1

Inflammation of the peritoneum

May be localised or generalised

Question 2

Aetiology of Peritonitis

Answer 2

Infectious: perforation, abdominal trauma, foreign body ingestion, iatrogenic, SBP (E. coli)

Non-infectious: Leakage of sterile body fluid into peritoneum (endometriosis, peptic ulcers, gastric carcinoma, pelvic trauma, pancreatitis, liver biopsy)

Question 3

What may cause perforation that can lead to peritonitis

Answer 3

Boerhaaves perforation
Peptic ulcer rupture
Gastric carcinoma rupture
Appendicitis 
Diverticulitis
Meckel diverticulum 
IBD 
Intestinal infarction
Intestinal strangulation
Colorectal carcinoma 
Meconium peritonitis 
Cholecystitis

Question 4

Symptoms of Peritonitis

Answer 4

Abdominal pain (generalised -> localised due to involvement of somatically innervated parietal peritoneal layer, | exacerbated by movement)
Bloating
Nausea and vomiting
Fever

Question 5

Signs of Peritonitis on examination

Answer 5

Diffuse abdominal tenderness
Patient lying still
Guarding / rigid abdomen 
Rebound tenderness
Sinus tachycardia 

Rovsing’s sign
Psoas sign
Obturator sign

Question 6

Investigations for Peritonitis

Answer 6

Surgery should be performed without any further delay if there is a strong suspicion

Ascitic tap: >250 polymorphonucleate cells

Erect CXR: Pneumoperitoneum
AXR: dilated oedematous intestines, Rigler’s sign

Question 7

Management for Peritonitis

Answer 7

Treat the cause

IV fluids and electrolytes
Antibiotics
Surgery (exploratory lap. + peritoneal lavage)

Question 8

Complications of Peritonitis

Answer 8

Sequestration of fluid and electrolytes -> electrolyte disturbance
Hypovolaemia -> shock, acute renal failure
Peritoneal abscess
Sepsis

Question 9

Prognosis of Peritonitis

Answer 9

Surgically correctable causes have a mortality rate <10%

Untreated may be fatal