Spontaneous bacterial peritonitis

Question 1

Definition

Answer 1

Inflammation of the peritoneum and associated with rupture of an internal organ

Question 2

Epidemiology + risk factors

Answer 2

MEN
* in women they can occur from ruptures to the reproductive organs such as an ectopic pregnancy, infected fallopian tube, or ovarian cyst
Previous medical history
Alcoholism
Weakened immune system
Chronic liver disease

Question 3

Aetiology

Answer 3

Infected peritonitis
- perforation of GI tract
- disruption of the peritoneum
- spontaneous bacterial peritonitis (MC)
- systemic infections
Non-infected peritonitis
- leakage of sterile bodily fluids into the peritoneum (blood, bile acid)
- auto-immune disease (lupus)
- Malignancy

Question 4

Pathophysiology

Answer 4

Inflammation from infection or irritation of the peritoneum
can be primary: spontaneous bacterial infection + ascites
Infection is mostly
- S. Aureus
- Klebsiella
- E. coli
or secondary to perforation of bowels, or appendix, or following infection from tubes breaking the skin, pancreatitis, trauma, invasive medical procedure ,
Perforation irritates through the leaked chemical such as:
- Bile
- Acids
- Old clotted blood
All ultimately get infected

Question 5

Symptoms

Answer 5

Sudden onset acute abdominal pain = exacerbated by any movement, e.g. coughing.
Often the pain may begin generalised but then become localised. This is because at first is may be the visceral nerve fibres = POORLY LOCALISED = poor sensation of pain that are activated and then later the parietal nerve fibres are activated = more inflamed = better localised pain
T5 - 9 = epigastric = greater splanchnic, foregut (up to 2nd part of duodenum)
T10-T11 = umbilical = lesser splanchnic, midgut (up to 2/3 transverse colon)
T12 = hypogastric = least splanchnic = hind gut (up to rectum)
RIGIDITY HELPS PAIN
Shock and fever
Washboard rigidity
Fever
Pulse >100 (sinus tachycardia) – the rhythm will still be normal.
Severe abdominal pain
Nausea and vomiting
Abdominal swelling
Dullness may occur after 2-4 hours.

Question 6

Diagnosis

Answer 6

Ascitic tap shows neutrophilia, cultures (MC + S) shows causative organism
ESR + CRP
Exclude pregnancy as cause (B-hCG test)
Erect CXR shows air under the diaphragm = indicates perforated colon

Question 7

Treatment

Answer 7

ABCDE
Treat underlying cause: IV fluids + IV Abx (cefotaxime, metronidazole)
Peritoneal lavage (clean the cavity surgically)

Question 8

Complications

Answer 8

Septicaemia
Suprapubic/Pelvic abscesses
Paralytic ileus