Peritonitis Flashcards
Define peritonitis
Inflammation of the peritoneum
Aetiology of peritonitis
Infectious:
GI perforation:
External:
- Abdominal trauma
- Ingestion of sharp foreign body
- Endoscopy
- Surgery
Spontaneous bacterial peritonitis
- E. Coli
- Klebsiella
- Streptococcus
Leakage of sterile body fluid into peritoneum (which may become subsequently infected)
- Blood: endometriosis, abdominal trauma
- Gastric juice: peptic ulcer, gastric carcinoma
Bile: liver biopsy
- Urine: pelvic trauma
- Menstruum: salpingitis
- Pancreatic juice: pancreatitis
Sterile abdominal surgery
What may cause perforation that can lead to peritonitis
Boerhaaves perforation
Peptic ulcer rupture
Gastric carcinoma rupture
Appendicitis
Diverticulitis
Meckel diverticulum
IBD
Intestinal infarction
Intestinal strangulation
Colorectal carcinoma
Meconium peritonitis
Cholecystitis
Symptoms of Peritonitis
Abdominal pain (generalised → localised due to involvement of somatically innervated parietal peritoneal layer, | exacerbated by movement)
Bloating
Nausea and vomiting
Fever
Signs of Peritonitis on examination
Diffuse abdominal tenderness
Patient lying still
Guarding / rigid abdomen
Rebound tenderness
Sinus tachycardia
Rovsing’s sign (palpation of the LIF causes pain in the RIF)
Psoas sign (extending the right thigh to the left lateral position elicits RLQ pain)
Obturator sign (internal rotation of the flexed right thigh elicits pain in the RLQ)
Investigations for Peritonitis
FBC, CRP, Blood cultures, U&Es, LFTs
US: ?ascites
Ascitic tap: >250 polymorphonucleate cells per uL
Erect CXR: pneumoperitoneum
AXR: dilated oedematous intestines
Management for peritonitis
Treat the cause of peritonitis
Supportive:
- IV fluids
- Correct electrolytes
- Abx: piptazobactam (tazocin)or cefotaxime
Surgery (exploratory laparotomy + lavage of peritoneum)
Prophylaxis for peritonitis
Prophylaxis: ciprofloxacin + propranolol (beta blocker)
If you have an ascites and a protein (not SAAG) of ≤15g/L, then START prophylaxis
Complications of peritonitis
Sequestration of fluid and electrolytes → electrolyte disturbance, hypovolaemia
Hypovolaemia → shock, acute renal failure
Peritoneal abscess
Sepsis