Peritonitis Flashcards
What is peritonitis?
Inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised.
What causes localised peritonitis?
- Appendicitis
- Cholecystitis
- Diverticulitis
- Salpingitis (inflammation of the fallopian tubes)
What is the difference between localized and generalized peritonitis?
Local peritonitis refers to loculi of infection, usually walled-off or contained by adjacent organs, whereas diffuse is synonymous with generalized peritonitis, that is spread to the entire cavity.
- Localised and secondary generalised peritonitis is COMMON in surgical patients
What is the difference between primary vs secondary generalised peritonitis?
Primary involves bacterial infection of the peritoneal cavity without an obvious source , whereas in secondary, the infection or injury usually starts from another point.
What are the causes of primary generalised peritonitis?
Bacterial infection of the peritoneal cavity without an obvious source
- Could be via haematogenous or lymphatic spread or ascending infection from the female genital tract
- Primary peritonitis is RARE
- Primary peritonitis is usually seen in adolescent females
What causes secondary generalised peritonitis?
Caused by bacterial translocation from a localised focus
- Could be non-bacterial due to spillage of bowel contents, bile and blood (e.g. perforated peptic ulcer)
What are the risk factors for peritonitis?
Ascites
Nephrotic syndrome
What are the presenting symptoms of peritonitis?
- Do a full SOCRATES for peritonitis
- Inflammation of the parietal peritoneum is usually continuous, sharp, localised, exacerbated by movement and coughing
- Symptoms may be vague in those with liver disease and ascites (due to confusion caused by encephalopathy)
What signs of peritonitis can be found on physical examination?
- Check vital signs and look for signs of dehydration or compromised perfusion (e.g. due to sepsis or hypovolaemia)
- Localised Peritonitis
- Tenderness on examination
- Guarding
- Rebound tenderness
- Generalised Peritonitis
- Very unwell
- Systemic signs of toxaemia or sepsis (e.g. fever, tachycardia)
- The patient will lie still
- Shallow breathing
- Rigid abdomen
- Generalised abdominal tenderness
- Reduced bowel sounds (may be absent due to paralytic ileus) - Ileus is the medical term for the lack of movement somewhere in the intestines leading to a buildup and potential blockage of food material. Paralytic ileus is obstruction of the intestine due to paralysis of the intestinal muscles
- DRE may show anterior tenderness (suggests pelvic peritonitis)
What investigations are used to diagnose/ monitor peritonitis?
- Paracentesis (Ascitic Fluid Absolute Neutrophil Count) → >250 cells/mm³. Diagnostic for spontaneousbacterial peritonitis (SBP).
- Ascitic Fluid Culture → determine causative organism
How is peritonitis managed?
- Empirical IV Antibiotics → cefotaxime
- IV Albumin (modulates the distribution of fluid between body compartments.)
- If ascitic fluid protein concentration <15 g/L or a previous episode of SBP → continuous antibiotic prophylaxis (oral ciprofloxacin or norfloxacin)
What possible early complications may arise from peritonitis?
- Septic shock
- Respiratory failure
- Multiorgan failure
- Paralytic ileus
- Wound infection
- Abscesses
What possible late complications may arise from peritonitis
Incisional hernia
Adhesions
Summarise the prognosis for patients with peritonitis
- One-year SBP recurrence rates as high as 69% have been reported. Renal dysfunction is the best predictor of mortality.
- Localised peritonitis usually resolves with treatment of the underlying cause
- Generalised peritonitis has a much higher mortality (30-50%)
- Primary peritonitis has a good prognosis with antibiotic treatment
- SBP has a mortality > 30% if diagnosis and treatment is delayed
Describe the epidemiology of peritonitis
- Primary peritonitis is RARE
- Primary peritonitis is usually seen in adolescent females
- Localised and secondary generalised peritonitis is COMMON in surgical patients
