Peritonitis

Question 1

Define Peritonitis

Answer 1

Inflammation of the peritoneum

Question 2

What are different ways to classify peritonitis

Answer 2

Based on onset (acute or chronic)
Source of origin (Primary or Secondary)
Cause (Bacterial or chemical)
Location (localised or generalised)

Question 3

Causes of peritonitis

Answer 3

• Perforation of hollow viscus
• > Contamination of cavity with secretions, organism, e.g. peptic ulcer, colonic diverticulum, appendix, bladder
• Inflammation of abdominal organs -> Appendix, pancreas, small bowel, colon, gall bladder
• Peritoneal dialysis patient
• Tuberculosis
• Ischaemia hollow viscus
• Chemical - contamination

Question 4

Epidemiology of peritonitis

Answer 4

Extremely rare
<1% adults
2% children

Question 5

Risk groups of peritonitis

Answer 5

Liver disease (SBP)
Females
Immune compromised (post-splenectomy)
Peritoneal dialysis patient
Ascites

Question 6

What is SBP

Answer 6

Spontaneous Bacterial Peritonitis

Question 7

Presentation of acute peritonitis (most peritonitis)

Answer 7

Pain - site, nature, progress
Tenderness - localised (progression to generalised)
Systemic symptoms - nausea, chills and rigor, dizziness, weakness and inability to move due to pain

Question 8

Clinical presentation of peritonitis

Answer 8

Pyrexia, tachycardia, confusion (encephalopathy)
Hypotension, hypoxia (late signs of shock)
Abdomen examination:
-Guarding, rebound, rigidity
-Silent abdomen (ominous sign)

Question 9

How to differentiate generalised and localised peritonitis

Answer 9

Patients lie still
Localised = avoid strain on part affected
Generalised = lie very still

Question 10

Diagnosis of peritonitis

Answer 10

Blood tests - FBC, U/Es, Amylase, LFTs
Plain X-ray (chest - erect perforation; abdomen - supine)
CT scan abdomen
*Ascites lactate level >25mg/dL

Question 11

How would you define SBP

Answer 11

Absolute neutrophil count>250 cells/mm^3

Question 12

Treatment of peritonitis

Answer 12

Resuscitate (e.g. SBP)
-ABC prinicple (airway breathing circulation) + antibiotics
Treat the cause:
Medical (only for primary peritonitis) or surgical

Question 13

Examples of primary peritonitis

Answer 13

SBP
Pelvic inflammatory disease
PD related peritonitis

Question 14

Surgical treatment of peritonitis

Answer 14

Repair of perforated viscus - peptic ulcer

Excision of perforated organ (with or without drainage/restoring continuity)