peritonitis

Question 1

primary peritonitis

Answer 1

• diffuse infection without loss of GI tract integrity

Question 2

secondary peritonitis

Answer 2

acute infection resulting from loss of GI tract integrity or from infected viscera

Question 3

tertiary peritonitis

Answer 3

recurrent infection of peritoneal cavity following adequate initial therapy

Question 4

causative agents

Answer 4

polymicrobial infection (more than 1)

bacteria:

• enterobacteriaceae
• anaerobes
• enterococci

Question 5

anaerobes involved in peritonitis and gram stain

Answer 5

gram -ve bacilli = bacteriodes fragilis

gram +ve cocci = peptostreptococcus

gram +ve bacilli = clostridium

Question 6

route of transmission

Answer 6

from GI tract to peritoneum via perforation (secondary)

- mainly from appendicitis, diverticulitis

Question 7

risk factors

Answer 7

primary = liver disease, portal hypertension, ascites

secondary = appendicitis, diverticulitis, surgery

tertiary = immune deficiencies, previous case

Question 8

presentation of peritonitis

Answer 8

• fever
• increased RR and HR
• nausea and vomiting
• diffuse abdominal pain
• rebound tenderness
• abdominal wall rigidity

Question 9

diagnostic tests

Answer 9

• CT or US show fluid accumulation and inflammation

- laparoscopic exam for diagnosis

Question 10

treatment

Answer 10

• symptomatic (fluids, pain relief, drain pus)
• establish cause and control origin (drain pus, dead tissue, corrective surgery)
• broad spectrum antibiotics 1-2 weeks

Question 11

pathogenesis

Answer 11

• bacteria gain entry, not cleared
• necrotic tissue (low BS) presence of nutrients causes ineffective clearance
• bacteria proliferates -> inflammation -> fluid exudate in cavity -> dilutes immune factors & reduces BV

often abscesses form (fibrin trapping bacteria) preventing phagocytosis & immune access