Surgical Peritonitis and Other Diseases of the Peritoneum, Mesentery, Omentum, and Diaphragm

Question 1

The peritoneum

Answer 1

The peritoneum is the largest serous membrane of the human body, with an estimated surface area of 1.8 m2, which is almost the same area as the skin (or total body surface area).

Question 2

consist of 3 layers

Answer 2

the mesothelium, the basal lamina, and the submesothelial stroma.

Question 3

valuable in confirming the diagnosis of surgical peritonitis.

Answer 3

CT and peritoneal lavage

Question 4

Antibiotics

Answer 4

In community-acquired peritonitis, susceptible gram-negative bacilli, strict anaerobic bacteria, and enterococci are typically found.

Health care–associated infec- tions, the flora may have been altered by previous antibiotic exposure and previous disease, with more antibiotic-resistant organisms present.

second- generation cephalosporins, third-generation cephalosporins, broad-spectrum beta-lactams, fluoroquinolones and metronida- zole, and aminoglycosides with clindamycin or metronidazole.

Question 5

Nosocomial infections occurring in
patients after long periods of hospitalization may include infec-
tions with multiresistant

Answer 5

Pseudomonas, Enterobacter, Enterococcus,

Staphylococcus, and Candida species.

Question 6

remains the gold standard for definitive diagnosis and mainstay of therapy in surgical peritonitis.

Answer 6

Laparotomy

Question 7

Primary Peritonitis

Answer 7

SBP, or peritonitis without a known surgical source, is the most common cause of primary peritonitis.

Question 8

Peritonitis With Continuous Ambulatory Peritoneal

Dialysis

Answer 8

Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment of end-stage kidney disease

The most common isolates are Staphylococcus epidermidis and other skin flora. Other pathogens, such as gram-negative bacilli, including Pseudomonas species, fungi, or Mycobacterium tuberculosis, are less frequent.

The intraperitoneal route of administration is now preferred to the IV route.

Question 9

Tuberculous Peritonitis

Answer 9

Patients with HIV infection, cirrhosis, diabetes mellitus, and underlying malignancy are at increased risk.

Question 10

Noncirrhotic patients with tuberculous perito- nitis usually have ascites with a high protein content, low glu- cose concentration, and a low serum-to-ascites albumin gradient (<1.1 g/dL).

elevated ascitic fluid WBC count with a lymphocytic predominanc

Answer 10

Tuberculous Peritonitis

an enzyme-linked immunospot assay (ELISPOT) and PCR assay (Xpert MTB/ RIF) are novel, rapid, noninvasive tests for M. tuberculosis.

Tuberculous peritonitis may also appear as a pelvic mass on CT, with high serum levels of CA125

Question 11

perihepatitis was formerly most commonly associated with Neisseria gonorrhoeae infection.

Chlamydia perihepati- tis occurs only in women, owing to seeding of bacteria into the peritoneal cavity from the fallopian tubes

Answer 11

Fitz-Hugh-Curtis Syndrome or Chlamydia Peritonitis

Question 12

PERITONEAL TUMORS

Answer 12

Metastatic cancer is by far the most common peritoneal tumor

Malignant bowel obstruction is a common terminal event for patients presenting with peritoneal metastases.

Question 13

The pathognomonic manifestations of peritoneal metastases

Answer 13

ascites and malignant bowel and ure- teral obstructions, which may occur independent of each other.

Question 14

Sister Mary Joseph

Answer 14

abdominal wall metastases (including umbilical nodules

Question 15

Pseudomyxoma Peritonei

Answer 15

syndrome of mucinous ascites that, although pri- marily associated with appendiceal epithelial neoplasms, can also occur with ovarian, pancreatic, colorectal, and gastric mucinous tumors.

Definitive diagnosis is made when characteristic jelly-like material is encountered at laparotomy or laparoscopy.

Question 16

Primary peritoneal

Answer 16

Taxane/carboplatin (neoadjuvant/adjuvant)

Question 17

(giant or follicular lymph node hyperplasia

considerable heterogeneity in the disease, but it is classified in unicentric and multicentric forms.

infection with human herpesvirus 8.

Answer 17

Castleman Disease

Question 18

primary inflammation of the colonic epiploic appendices) is an entity that is occasionally seen and is often con- fused with the diagnosis of appendicitis.

Answer 18

Epiploic Appendagitis

diagnosed by CT, and the treatment is nonoperative if the diagnosis can be made.