Peritonitis

Question 1

what is the peritoneal cavity?

Answer 1

a potential space located between the parietal and visceral peritoneum, which contains a small amount of fluid (~50ml)

Question 2

what is primary peritonitis?

Answer 2

• spontaneous bacterial invasion of the peritoneal cavity (e.g. spontaneous bacterial peritonitis)
• seen in patients with pre-existing ascites

Question 3

what is secondary peritonitis?

Answer 3

• peritoneal infection due to loss of integrity of the gastrointestinal or urogenital tracts
• this leads to contamination of the peritoneal space

Question 4

what is tertiary peritonitis?

Answer 4

recurrent or persistent infection of the peritoneal cavity that typically occurs after secondary peritonitis

Question 5

what are the potential sites of perforation that cause peritonitis?

Answer 5

• oesophagus (e.g. trauma, boerhaave syndrome, malignancy)
• stomach (e.g. malignancy, PUD)
• pancreas (e.g. pancreatitis)
• HPB (e.g. gallstones, cholecystitis, malignancy)
• small intestine (e.g. ischaemic bowel, strangulated hernia)
• colon (e.g. diverticulitis, malignancy)

Question 6

what are the risk factors for peritonitis?

Answer 6

• peritoneal dialysis
• cirrhosis
• appendicitis
• PUD
• diverticulitis
• crohn’s
• pancreatitis

Question 7

what are the symptoms of peritonitis?

Answer 7

• acute, severe abdominal pain
• fever
• nausea
• vomiting
• tachycardia
• hypotension
• abdominal distension
• anorexia
• sweating
• tenderness on palpation
• guarding
• rigidity
• percussion tenderness
• absent, or reduced, bowel sounds

Question 8

what are the investigations for peritonitis?

Answer 8

• FBC
• U&Es
• LFTs
• VBG/ABG
• CRP
• coagulation
• G&S +/- crossmatch
• CT abdomen + pelvis

Question 9

what is the management of peritonitis?

Answer 9

• broad-spectrum, high-dose antibiotic
• exploratory laparotomy