Peritonitis

Question 1

define peritonitis?

Answer 1

inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised.

Question 2

what are the catagories of peritonitis?

Answer 2

• localised
• primary generalised
• secondary generalised

Question 3

what might cause localised peritonitis?

Answer 3

o Appendicitis
o Cholecystitis
o Diverticulitis
o Salpingitis

Question 4

what is primary generalised peritonitis?

Answer 4

o Bacterial infection of the peritoneal cavity without an obvious source

Question 5

what is Secondary Generalised Peritonitis?

Answer 5

Caused by bacterial translocation from a localised focus

Question 6

epidemiology of peritonitis?

Answer 6

• Primary peritonitis is RARE
• Primary peritonitis is usually seen in adolescent females
• Localised and secondary generalised peritonitis is COMMON in surgical patients

Question 7

signs of localised peritonitis on examination?

Answer 7

o Tenderness on examination
o Guarding
o Rebound tenderness

Question 8

signs of generalised peritonitis on examination?

Answer 8

o	Very unwell 
o	Systemic signs 
o	The patient will lie still 
o	Shallow breathing  
o	Rigid abdomen 
o	Generalised abdominal tenderness  
o	Reduced bowel sounds

Question 9

what bloods should be done when suspecting peritontis?

Answer 9

o	FBC 
o	U&Es 
o	LFTs 
o	Amylase  
o	CRP  
o	Clotting  
o	Group & Save or Cross-match  
o	Blood cultures  
o	Pregnancy test  
o	ABG

Question 10

what imaging should be undertaken when suspecting peritonitis?

Answer 10

o Erect CXR (check for air under the diaphragm)
o AXR (check for bowel obstruction)
o USS or CT abdomen
o Laparoscopy

Question 11

what investigations should be used when ascites is present?

Answer 11

o Ascitic tap and cell count

Question 12

how to manage localised peritonitis?

Answer 12

o Depends on CAUSE
o Some causes may require surgery (e.g. appendicitis)
o Some causes can be treated with antibiotics (e.g. salpingitis)

Question 13

how to manage generalised peritonitis?

Answer 13

o	Laparotomy  
•	Remove the infected or necrotic tissue  
•	Treat cause  
•	Peritoneal lavage  
o	IV fluids  
o	IV antibiotics  
o	Urinary catheter  
o	NG tube  
o	Central venous line

Question 14

how is primary generalised peritonitis managed?

Answer 14

• treated by antibiotics

Question 15

what are the features of spontaneous bacterial peritonitis?

Answer 15

• seen by patients with ascites secondary to liver cirrhosis
• caused by E.coli
• o Paracentesis = neutrophils >250

Question 16

how is SBP managed?

Answer 16

o IV cefotaxime given to manage

o Oral ciprofloxacin given prophylactically

Question 17

complications of peritonitis?

Answer 17

•	Early 
o	Septic shock  
o	Respiratory failure  
o	Multiorgan failure  
o	Paralytic ileus  
o	Wound infection  
o	Abscesses  
•	Late 
o	Incisional hernia  
o	Adhesions

Question 18

prognosis for localised peritonitis?

Answer 18

• Localised peritonitis usually resolves with treatment of the underlying cause

Question 19

prognosis for generalised peritonitis?

Answer 19

• Generalised peritonitis has a much higher mortality (30-50%)

Question 20

prognosis for primary peritonitis?

Answer 20

good prognosis with antibiotic treatment

Question 21

prognosis for SBP?

Answer 21

mortality > 30% if treatment is delayed