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Phase II: Periop Pt1 > Peritonitis > Flashcards

Flashcards in Peritonitis Deck (27):
1

How can you differentiate between peritonitis and renal colic?

Peritonitis features pain when coughing and moving.

Renal colic features pain when staying still, relieved by moving. "Cannot sit still"

2

Name 3 clinic symptoms of peritonitis?

Anorexia
Pyrexia
Several generalised abdominal pain, radiating to shoulders and back
Pain worse with movement, coughing, sneezing

3

What scenario may feature peritonitis with apyrexia?

Patients taking corticosteroids

4

How can the causes of peritonitis be grouped?

Primary (rare)
Secondary (common)

5

Name 3 clinical signs of peritonitis

Pyrexia
Tachycardia
Peritonism: Tenderness and guarding, Rebound tenderness
Localised pain during distant palpation (Rovsing's sign)

6

What is the most likely cause of primary peritonitis?

Streptococcal infection via blood stream.

Rare, usually occurs in immunocompromised patients.

7

List 4 common causes of secondary peritonitis

Acute perforated appendicitis
Acute perforated diverticular disease
Upper GI perforation
Perforated tumour (colonic or gastric)
Perforated ischaemic bowel
Acute pancreatitis
Peritoneal dialysis
Post-surgical intervention

8

What is the commonest cause of secondary peritonitis in under 45s?

Acute perforated appendicitis

9

What is the commonest cause of secondary peritonitis in elderly?

Acute perforated diverticular disease

10

How is a perforation diagnosis confirmed?

Laparotomy - surgical incision to examine abdominal organs

11

What is acute peritonitis?

Acute inflammation of the peritoneal cavity

12

Name 3 features that suggest a perforated viscus

Sudden onset of pain
Constant severe pain
Pain aggravated by movement, coughing, sneezing
Diffuse tenderness
Silent rigid abdomen

13

What investigation may be raised in perforated bowel?

Serum amylase - suggestive of pancreatitis

14

What laboratory investigations may be done in acute peritonitis?

FBC
U&E
CRP
Amylase - pancreatitis
ABG - if shocked or pancreatitis suspected

15

What is the investigation of choice for diagnosing acute peritonitis?

Abdominal CT

Excludes acute pancreatitis, and often locates the probable source of pathology.

16

Outline the early treatment of acute peritonitis

IV antibiotics when diagnosis is unclear. Especially useful if surgery is likely.

Analgesia
Correct fluid balance
Monitor

17

Outline the definitive management of acute peritonitis

Management depends on the cause of peritonitis.

18

Differentiate between local and generalised peritonitis

Local: peritonism over a single area
General: peritonism over entire abdomen with board-like rigidity

Generalised peritonitis is also more likely to have signs of:
-Ileus (distension, vomiting, tympanic abdomen with reduced/absent bowel sounds)
-Systemic shock (tachycardia, tachypnoea, hypotension, low urine output).

19

What is the management of generalised peritonitis?

*Surgical emergency*
IV fluid resuscitation
IV ABX
Laparotomy/Laparoscopy - peritoneal wash-out and treatment of underlying condition
Monitor for post-op complications

20

What are the causes of generalised peritonitis?

Bacterial infection - faecal matter from diverticulitis
Progression from localised inflammatory peritonitis
Leakage of body fluids
-Gastric juice
-Bile
-Urine
-Pancreatic juice
-Blood

*Body fluids are initially sterile but become infected with 24-48hr of leaking.

21

In what scenario can a CT abdomen be considered in generalised peritonitis?

If it can be performed urgently and the patient is stable.

*Does not change management

22

Name 3 bedside tests useful for diagnosing local peritonitis

Rebound tenderness
Cough test
Hip flexion test

23

What would indicate the development of a peritoneal abscess?

Swinging fever
Swelling
Raised WCC
Increasing or sustained pain

24

How is a peritoneal abscess managed?

Percutaneous drainage or laparotomy

25

What investigations should be done in generalised peritonitis?

CT abdomen - if quick and patient is stable
Serum amylase - to exclude pancreatitis

26

What is the complication of delaying treatment of generalised peritonitis?

Further toxaemia, septicaemia, and multi organ-failure

27

What initial radiological test should be performed for suspected perforation? What sign is evident?

Erect CXR to look for pneumoperitoneum

AXR would show Rigler sign (double wall)