acute peritonitis (acute abdomen)

Question 1

what are 3 retroperitoneal structures? Does irritation of these structures cause peritonitis?

Answer 1

-ascending and descending colon
-pancreas
-duodenum
No. Irritation of these does not cause peritonitis.

Question 2

what are 3 peritoneal structures? Does irritation of these structures cause peritonitis?

Answer 2

-stomach
-colon
-ovaries/fallopian tubes (ectopic pregnancy)
Yes. Irritation of these CAN cause peritonitis.

Question 3

why is acute peritonitis (acute abdomen) an emergency?

Answer 3

they can go into septic shock and die.

Question 4

what are the red flags on imaging that indicate a patient probably needs surgery?

Answer 4

• free air
• pneumatosis (air within bowel wall, means ischemia of bowel)
• portal venous gas (air entered blood stream, effect of pneumatosis)
• air within liver

Question 5

T/F: a peptic ulcer can cause peritonitis

Answer 5

False. Must be something large, like an intestinal obstruction.

Question 6

T/F: peritonitis usually affects the visceral peritoneum

Answer 6

false. usually affects the parietal peritoneum.

Question 7

red flags on physical exam for acute peritonitis (need to be admitted, probably need surgery)

Answer 7

• hypotension
• confusion or impaired consciousness
• septic looking
• rigid abdomen

Question 8

two major pitfalls of imaging in acute peritonitis

Answer 8

• remember to order CT of abdomen AND pelvis, not just abdomen
• Don’t wait for the radiologist to read the CT! you don’t have that kind of time.