Peritonitis

Question 1

Which conditions increase your risk of SBP?

Answer 1

decompensated liver cirrhosis and end-stage liver disease

Question 2

what is the most common cause of SBP?

Answer 2

E.coli

Question 3

Which type of bacteria usually cause SBP?

Answer 3

gram-negative

Question 4

what are the symptoms of peritonitis?

Answer 4

Vomiting/ nausea
Fever/pyrexia
Abdominal swelling
Abdominal pain
Diarrhoea or constipation
Altered mental status
Signs of sepsis eg. hypotension, tachycardia

Question 5

What are the signs of peritonitis?

Answer 5

Flank dullness
Shifting dullness
Fluid wave/thrill
Involuntary abdominal guarding
Rebound tenderness
Rigidity

Question 6

What are the risk factors for SBP?

Answer 6

decompensated cirrhosis
ascites
GI bleeding
Endoscopic scleropathy
Low ascitic protein

Question 7

Differentials for peritonitis?

Answer 7

SBP
Secondary peritonitis
Pancreatic peritonitis
Tuberculous peritionitis
Intra-peritoneal haemorrhage

Question 8

What blood tests should be done for peritonitis?

Answer 8

FBC
LFTs
CRP
Albumin
Blood culture
PTT/INR

Question 9

what would you expect to see on an LFT in SBP?

Answer 9

Increased liver enzymes and bilirubin

Question 10

what would you expect serum albumin levels to be in SBP?

Answer 10

low

Question 11

what would you expect to see in haemorrhaging peritonitis on a PTT/INR

Answer 11

increased

Question 12

What would you test for in peritonitis in a US-guided abdominal paracentesis?

Answer 12

Appearance
Neutrophils
LDH, glucose, protein
Culture
Carcinoembryonic antigen
Alkaline phosphatase

Question 13

Which would be your first choice antibiotics for community-acquired SBP?

Answer 13

cefotaxime or ceftriaxone

Question 14

Which would be your first choice antibiotics for nosocomial-acquired SBP?

Answer 14

piperacillin/tazobactam or imipenem/cilastatin

Question 15

what are the complications of SBP?

Answer 15

sepsis
tense ascites
renal failure
bleeding after paracentesis
bowel perforation after paracentesis
leakage from the paracentesis puncture site

Question 16

what does increased creatinine indicate in peritonitis?

Answer 16

hepatorenal syndrome

Question 17

In secondary peritonitis, which ascitic fluid criteria would you expect at least 2 of to be satisfied?

Answer 17

Glucose <2.8mmol/L
Total ascitic protein >10g/L
LDH >225 U/L

Question 18

which markers MAY be increased in secondary peritonitis?

Answer 18

carcinoembryonic antigen >5microgram/L

Alkaline phosphatase >240 U/L

Question 19

What are the complications of secondary peritonitis?

Answer 19

enterocutaneous fistula
Surgical site infection
Sepsis
Multiorgan failure

Question 20

how would you test for tuberculous peritonitis?

Answer 20

tuberculin skin testing
sputum smear/culture
Lymph node fine-needle aspiration
Peritoneal biopsy
Nucleic acid amplification test (NAAT)

Question 21

what would you expect to find in a peritoneal biopsy in tuberculous peritonitis?

Answer 21

caseating granulomas and acid-fast bacilli

Question 22

what would you expect to find in ascitic fluid analysis in tuberculous peritonitis?

Answer 22

exudate
low SAAG unless cirrhotic
Adenosine deaminase levels elevated
Elevated free interferon-gamma levels - positive for mycobacterium tuberculosis

Question 23

Which combinations of drugs for tuberculous peritonitis would you use in the acute phase?

Answer 23

Isoniazid
Rifampicin
Ethambutol
Pyrazinamide IF NOT pregnant

Question 24

how long do you give tuberculosis medication for in the acute phase?

Answer 24

8 weeks

Question 25

which combination of drugs would you give in the continuation phase of tuberculous peritonitis and how long for?

Answer 25

18 weeks
Isoniazid and rifampicin
If pregnant or at risk of neuropathy, add pyridoxine