peritonitis Flashcards
(23 cards)
define peritoneum
a serous membrane lining the abdominal cavity and covering abdominal organs
layers of peritoneum
- Parietal peritoneum: Lines the abdominal wall
- Visceral peritoneum: Covers the abdominal organs
peritoneal cavity
Space between the two layers containing serous fluid for lubrication
functions of peritoneum
- Supports abdominal organs
- Provides a conduit for blood vessels, lymphatics, and nerves
- Facilitates immune response and fluid exchange
what cells of the peritoneum facilitate rapid healing
mesothelial
define peritonitis and why its a medical emergency
- Inflammation of the peritoneum (lining of the abdominal cavity).
- The peritoneal cavity is sterile in normal conditions.
Medical emergency requiring prompt diagnosis and treatment.
types of peritonitis
- primary
- secondary
- tertiary
primary peritonitis
SPONTANEOUS BACTERIAL PERITONITIS
- no evidence sourse of infection
- girls 3-9yrs
organisms:
- pneumococci
- streptococci
- haemophilus
- goonococcus
- gram -ve
common in patients with liver cirrhosis
secondary peritonitis
- due to perforation of an abdominal organ
- E.coli
- most common - duodenal perforation + burst appendicitis
tertiary peritonitis
- persistence/recurrent infection after initial treatment
organisms origin in each type
primary
- monomicrobial
- extraperitoneal source
- blood spread
secondary
- most common
- poly microbial
- intra-peritoneal source
tertiary
- super added infection
types of bacteria and where they’re from
GI tube bacteria
- E. coli
- aerobic + anaerobic strep
- strep faecalis
- staph
- klebsiella
not from GI tube
- gonococcus
- pneumococcus
- from fallopian tubes
- chlamydia
- beta haemolytic strep
method of infection
Perforation of GIT
Penetrating or blunt trauma
Surgery
Drains
Dialysis
Foreign body
Appendicitis, cholecystitis, diverticulitis
Intestinal obstruction with strangulation
Via fallopian tube
Through blood spread
Transmural spread
Following uterine perforation/injury during abortion/termination of pregnancy
symptoms
Severe abdominal pain
Nausea and vomiting
Fever and chills
Inability to pass gas or stool
signs
Abdominal tenderness, rigidity (board-like abdomen)
Rebound tenderness
Hypotension, tachycardia (signs of sepsis)
early diffuse peritonitis (6)
- Abdominal pain ( worse by moving or breathing)
- Tenderness
- Generalised guarding - voluntary contraction of the abdominal wall musculature to avoid pain
- Infrequent bowel sounds ( paralytic ileus)
- Fever
- Tachycardia
diffuse peritonitis late (7)
- Generalised rigidity - involuntary tightening of the abdominal musculature
- Distension - abnormally swollen outwards
- Absent bowel sounds
- Circulatory failure
- Thready irregular pulse
- (Hippocratic face)
- Loss of consciousness
diagnosis
History and Physical Exam (focus on peritoneal signs)
Laboratory Tests:
CBC: Elevated WBC count
Blood cultures
Serum lactate
Imaging:
Abdominal X-ray (free air under diaphragm = perforation)
Ultrasound or CT scan (detect abscesses, fluid collection)
Paracentesis:
Ascitic fluid analysis (WBC > 250 cells/mm³ suggests infection)
management
Initial Stabilization:
- IV fluids and electrolyte correction
- Broad-spectrum IV antibiotics
- Oxygen therapy if needed
Definitive Treatment:
- Surgical intervention for secondary peritonitis (repair perforation, drain abscess)
- Medical management for SBP (antibiotics + albumin)
Prevention Strategies
- Early treatment of abdominal infections
- Proper technique in peritoneal dialysis
- Prophylactic antibiotics in high-risk cirrhotic patients
most common organisms
S.aureus, Klebsiella and E.coli
aetiology and nmemonic
Primary - spontaneous bacterial peritonitis
Secondary - perforated:
oesophagus
duodenal gastric ulcer
intestine
bc of:
- disease eg appendicitis, diverticulitis, infarction to these organs, colorectal cancer or IBD
OR
trauma
Ingestion of foreign body
infection:
spontaneous bacterial peritonitis
secondary to peritoneal dialysis
● A - appendicitis
● E - ectopic pregnancy
● I - infection
● O - obstruction
● U - ulcer
most common cause of spontaneous bacterial peritonitis
E. coli
most common causes of secondary peritonitis
duodenal periferation
burt appendicitis
