TH5 - ACUTE PERITONITIS Flashcards
ACUTE PERITONITIS
INFLAMMATION OF PERITONEAL CAVITY WHEN PERITONEAL FLUID INCREASE IN VOLUME WITH TRANSUDATE RICH IN LEUKOCYTE POLYMORPHS + FIBRIN
2 FORMS OF ACUTE PERITONITIS ACCORDING TO SOURCE OF INFECTION?
- PRIMARY - SPONTANEOUS
> infection de novo (new) within peritoneum - SECONDARY
> inflammatory process of peritoneum due to identifiable primary process
WHEN IS DIAGNOSIS OF PRIMARY PERITONITIS ACCEPTED?
> ONLY WHEN CAREFUL EXPLORATION OF PERITONEAL CAVITY DOESN’T ESTABLISH SOURCE OF INFECTION
> every case of acute peritonitis must be considered as secondary acute suppurative peritonitis - TX by operation
SOURCE OF INFECTION FOR ACUTE SECONDARY SUPPURATIVE PERITONITIS?
> GI perforation -MC source of infection
- perforated ulcer, appendix, diverticulum
> Transmural translocation - no perforation
- pancreatitis, ischemic bowel
> Exogenous contamination
- drains
- open surgery
- penetrating abdominal trauma
- female genital tract infection (pelvic inflammatory disease)
WHICH 2 SYNDROMES DEVELOP AS A RESULT OF MASSIVE ABSORPTION OF INFLAMMATORY MEDIATORS FROM PERITONEAL CAVITY IN CASE OF ACUTE SECONDARY SUPPURATIVE PERITONITIS?
- SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)
2. MULTI ORGAN DYSFUNCTION SYNDROME (MODS)
2 TYPES OF ACUTE PERITONITIS ACCORDING TO SPREAD OF INFLAMMATORY PROCESS?
- LOCALISED ACUTE PERITONITIS
2. GENERLISED ACUTE PERITONTIS
3 FLOORS OF PERITONEAL CAVITY?
UPPER - above mesocolon transversum (supra colic)
MIDDLE - btwn mesocolon transversum + linea inominata pelvis
LOWER - below linea inominata pelvis
TOTAL PERITONITIS?
Inflammatory process affecting 3 floors of peritoneal cavity
90-100% of peritoneal surface is affected
DIFFUSED PERITONITIS?
Inflammatory process passes outside 2 neighbouring peritoneal area but doesn’t affect more than 2 peritoneal floors
SUBTYPES OF LOCALISED PERITONITIS?
2 SUBTYPES: LOCALISED PERITONITIS
> LOCAL CONFINED PERITONITIS
- intraperitoneal abscess
> LOCAL NON-CONFINED PERITONITIS
- inflammatory process doesn’t pass outside of 2 neighbouring peritoneal floors
5 SUBTYPES OF INTRAPERITONEAL ABSCESS ACCORDING TO THEIR LOCATION?
- left subphrenic
- right subphrenic
- left sub hepatic
- right sub hepatic
- pelvic abscess
MOST COMMON SITE FOR INTRAPERITONEAL ABSCESS FORMATION?
PELVIS
- vermiform appendix often in pelvic position
- fallopian tube also MC site of infection
- pelvic abscess also occurs to any case of diffuse peritonitis + common after anastomotic leakage following colorectal surgery
ABDOMINAL
SIGNS OF INTRAPERITONEAL ABSCESS?
> LOCALISED GUARDING
REBOUND TENDERNESS
RIGIDITY
PHYSICAL SYMPS OF PELVIC ABSCESS?
> MARKED TENDERNESS
> BULGING OF ANTERIOR RECTAL WALL
FIRST CHOICE OF IMAGING METHOD TO SEE PRESENCE OF LOCALISATION OF INTRAPERITONEAL ABSCESS?
ABDOMINAL ULTRASOUND
WHY CHEST X RAY + PLAIN RADIOGRAPHY IS IMPORTANT IN CASE OF SUBPHRENIC ABSCESS?
able to see collapse of lung or basal effusion or empyema
SUBPHRENIC ABSCESS?
DISEASE CHARACTERISED WITH ACCUMULATION OF FLUID BETWEEN DIAPHRAGM, LIVER + SPLEEN
MOST COMMON PX COMPLAINT IN PELVIC ABSCESS?
PELVIC PAIN
DIARROHEA
PASSAGE OF MUCUS IN STOOL
MAIN MANAGEMENT OF INTRAPERITONEAL ABSCESS?
DRAIN PUS
MANAGEMENT OF DIFFUSE/ TOTAL PERITONITIS?
ACUTE PERITONTIS > ABSOLUTE INDICATION FOR LAPARATOMY
> general > surgery to remove the cause of peritonitis + adequate peritoneal lavage + drainage
TYPE OF PELVIC ABSCESS DRAINAGE USED IN WOMEN?
VAGINAL DRAINAGE
PX WITH ABDOMINAL PAIN COMES TO ER
PX AVOIDS ACTIVITY THAT STRETCHES/ JOSTLES THE ABDOMEN
WHAT IS THE DX?
PERITONITIS
PRIMARY PERITONTIS MC IN?
CHILDREN
WHAT IS PNEUMOPERITONEUM?
AIR IN PERITONEAL CAVITY > tissue ischemia > erosion > infection > mechanical injury > thermal injury
