TH5 - ACUTE PERITONITIS

Question 1

ACUTE PERITONITIS

Answer 1

INFLAMMATION OF PERITONEAL CAVITY WHEN PERITONEAL FLUID INCREASE IN VOLUME WITH TRANSUDATE RICH IN LEUKOCYTE POLYMORPHS + FIBRIN

Question 2

2 FORMS OF ACUTE PERITONITIS ACCORDING TO SOURCE OF INFECTION?

Answer 2

1. PRIMARY - SPONTANEOUS
   > infection de novo (new) within peritoneum
2. SECONDARY
   > inflammatory process of peritoneum due to identifiable primary process

Question 3

WHEN IS DIAGNOSIS OF PRIMARY PERITONITIS ACCEPTED?

Answer 3

> 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

Question 4

SOURCE OF INFECTION FOR ACUTE SECONDARY SUPPURATIVE PERITONITIS?

Answer 4

> 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)

Question 5

WHICH 2 SYNDROMES DEVELOP AS A RESULT OF MASSIVE ABSORPTION OF INFLAMMATORY MEDIATORS FROM PERITONEAL CAVITY IN CASE OF ACUTE SECONDARY SUPPURATIVE PERITONITIS?

Answer 5

1. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)

2. MULTI ORGAN DYSFUNCTION SYNDROME (MODS)

Question 6

2 TYPES OF ACUTE PERITONITIS ACCORDING TO SPREAD OF INFLAMMATORY PROCESS?

Answer 6

1. LOCALISED ACUTE PERITONITIS

2. GENERLISED ACUTE PERITONTIS

Question 7

3 FLOORS OF PERITONEAL CAVITY?

Answer 7

UPPER - above mesocolon transversum (supra colic)

MIDDLE - btwn mesocolon transversum + linea inominata pelvis

LOWER - below linea inominata pelvis

Question 8

TOTAL PERITONITIS?

Answer 8

Inflammatory process affecting 3 floors of peritoneal cavity

90-100% of peritoneal surface is affected

Question 9

DIFFUSED PERITONITIS?

Answer 9

Inflammatory process passes outside 2 neighbouring peritoneal area but doesn’t affect more than 2 peritoneal floors

Question 10

SUBTYPES OF LOCALISED PERITONITIS?

Answer 10

2 SUBTYPES: LOCALISED PERITONITIS

> LOCAL CONFINED PERITONITIS
- intraperitoneal abscess

> LOCAL NON-CONFINED PERITONITIS
- inflammatory process doesn’t pass outside of 2 neighbouring peritoneal floors

Question 11

5 SUBTYPES OF INTRAPERITONEAL ABSCESS ACCORDING TO THEIR LOCATION?

Answer 11

1. left subphrenic
2. right subphrenic
3. left sub hepatic
4. right sub hepatic
5. pelvic abscess

Question 12

MOST COMMON SITE FOR INTRAPERITONEAL ABSCESS FORMATION?

Answer 12

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

Question 13

ABDOMINAL

SIGNS OF INTRAPERITONEAL ABSCESS?

Answer 13

> LOCALISED GUARDING
REBOUND TENDERNESS
RIGIDITY

Question 14

PHYSICAL SYMPS OF PELVIC ABSCESS?

Answer 14

> MARKED TENDERNESS

> BULGING OF ANTERIOR RECTAL WALL

Question 15

FIRST CHOICE OF IMAGING METHOD TO SEE PRESENCE OF LOCALISATION OF INTRAPERITONEAL ABSCESS?

Answer 15

ABDOMINAL ULTRASOUND

Question 16

WHY CHEST X RAY + PLAIN RADIOGRAPHY IS IMPORTANT IN CASE OF SUBPHRENIC ABSCESS?

Answer 16

able to see collapse of lung or basal effusion or empyema

Question 17

SUBPHRENIC ABSCESS?

Answer 17

DISEASE CHARACTERISED WITH ACCUMULATION OF FLUID BETWEEN DIAPHRAGM, LIVER + SPLEEN

Question 18

MOST COMMON PX COMPLAINT IN PELVIC ABSCESS?

Answer 18

PELVIC PAIN
DIARROHEA
PASSAGE OF MUCUS IN STOOL

Question 19

MAIN MANAGEMENT OF INTRAPERITONEAL ABSCESS?

Answer 19

DRAIN PUS

Question 20

MANAGEMENT OF DIFFUSE/ TOTAL PERITONITIS?

Answer 20

ACUTE PERITONTIS > ABSOLUTE INDICATION FOR LAPARATOMY

> general > surgery to remove the cause of peritonitis + adequate peritoneal lavage + drainage

Question 21

TYPE OF PELVIC ABSCESS DRAINAGE USED IN WOMEN?

Answer 21

VAGINAL DRAINAGE

Question 22

PX WITH ABDOMINAL PAIN COMES TO ER
PX AVOIDS ACTIVITY THAT STRETCHES/ JOSTLES THE ABDOMEN
WHAT IS THE DX?

Answer 22

PERITONITIS

Question 23

PRIMARY PERITONTIS MC IN?

Answer 23

CHILDREN

Question 24

WHAT IS PNEUMOPERITONEUM?

Answer 24

AIR IN PERITONEAL CAVITY 
> tissue ischemia 
> erosion 
> infection 
> mechanical injury 
> thermal injury

Question 25

WHAT IS THE DX WHEN THERE IS PENUMOPERITONEUM ON PLAIN X RAY RADIOGRAPH?

Answer 25

PERFORATED DUODENAL ULCER

Question 26

WHY ARE PX WITH PERITONITIS DEHYDRATED? HOW IS TX?

Answer 26

LOSS OF LIQUID IN THIRD SPACE

TX > IV fluid infusions

Question 27

HOW MANY PARTS FOR TO FLOOR OF PERITONEAL CAVITY?

Answer 27

3 FLOORS
> upper
> middle
> lower

Question 28

DIFFERENCE BETWEEN VISCERAL + PARIETAL PAIN?

Answer 28

VISCERAL PAIN - ORGANS
- vague + poorly localised

PARIETAL PAIN
- sharp + well localised

Question 29

METHOD OF FIRST CHOICE WHEN SUSPECTED WITH GENERALISED PERITONITIS?

Answer 29

PLAIN RADIOGRAPHY

Question 30

WHAT IS MC CAUSE FOR ABSCESS IN LEFT SUB HEPATIC SPACE?

Answer 30

COMPLICATED ACUTE PANCREATITIS