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Y4: Acute surgery > Peritonitis > Flashcards

Peritonitis Flashcards

1
Q

What is peritonititis?

A
  • Inflammation of the peritoneum
    • Acute vs chronic
    • Septic vs aseptic
    • Primary vs secondary
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2
Q

Name some of the causes of GI perforation?

A
  • Inflammatory or ischaemic
    • Chemical: peptic ulcer disease, foreign body
    • Infection: diverticulitis, cholecystitis, meckels diverticulum
    • Ischaemia: mesenteric, obstrcting lesions
    • Toxic megacolon
  • Traumatic
    • Iatrogenic: surgery
    • Penetrating or blunt trauma
    • Direct rupture: vomiting leaading to oesophageal perforation
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3
Q

What are the clinical features of GI perforation?

A
  • Pain
    • Rapid onset, sharp
    • Associated malaise, vomiting, lethargy
  • Features of peritonism (rigid)
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4
Q

Describe the investigations which should be performed in someone with a suspected perforation?

A
  • FBC, G&S, WCC, CRP
  • Urinarlysis
  • CXR
    • Free air under diaphragm
  • CT scan (gold standard)
    • Confirms free air presence and suggests a location
  • AXR:
    • Rigler’s sign
    • Psoas sign
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5
Q

What is Rigler’s sign?

A
  • AXR
  • Both sides of the bowel wall can be seen due to free intra-abdominal air acting as an additional contrast
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6
Q

What is psoas sign?

A
  • AXR
    • Loss of sharp definition of the psoas muscle border secondary to fluid in the retroperitoneum
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7
Q

Describe the management of a GI perforation?

A
  • Broad spectrum antibiotics
  • Nil by mouth + NG tube
  • Surgery for repair and contamination control
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8
Q

Describe the key aspects of surgical intervention for a GI perforation?

A
  • Identification and management of underlying cause
  • Management of perforation
    • Repair perforated peptic ulcer with an omental patch
    • Resect a perforated diverticulae via Hartmanns procedure
  • Thorough washout
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9
Q

What are the most important complications of a GI perforaiton?

A
  • Infection
    • Peritonitis
    • Sepsis
  • Haemorrhage
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10
Q

What is the most common type of peritonitis?

A

Acute suppurative peritonitis secondary to visceral disease

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11
Q

Describe the possible features of Chronic peritonitis secondary to peritoneal dialysis?

A
  • Abdominal pain
  • Ascites
  • Obstruction due to matting of the bowel from dense adhesions
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12
Q

Treatment for Chronic peritonitis seconary to peritoneal dialysis?

A
  • Removal of dialysis catheter
  • Drainage of local fluid collections under US guidance
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13
Q

Describe Aseptic peritonitis?

A
  • From chemical or foreign body irritants
  • Often followed by secondary bacterial peritonitis
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14
Q

Chemical causes of aseptic peritonitis?

A
  • Bile
  • Blood
  • Urine
  • Gastric contents
  • Meconium
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15
Q

Foreign body causes of aseptic peritonitis?

A
  • Talc
  • Starch
  • Cellulose
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16
Q

Describe the management of peritonitis?

A
  • Deal with underlying cause
    • eg repair perforation, resect infarcted bowel
  • Replace extracellular fluid
  • NG tube to prevent further vomiting
  • Antibiotic over for all those with established seondary peritonitis
17
Q

Describe Primary peritonitis?

A
  • Rare
  • E. coli is most common cause
    • Access through gut wall of distal blood-borne spread
18
Q

Features of primary peritonititis?

A
  • Abdominal tenderness
  • Fever
  • Leucocytosis
  • Abdominal rigidity is uncommon
19
Q

Describe Post-operative peritonitis?

A
  • Effect of original disease or direct complication of surgery (anastomotic leak)
  • Suspect if:
    • Persistent abdominal distension
    • Development of vomiting after apparent return to normal
20
Q

Why is the diagnosis of post-operative peritonitis often difficult?

A
  • Patient is often on post-op analgesia so may not be in pain
  • Pain or tenderness often attributed to surgical wound
  • 48hr post-surgery period where bowel sounds are absent and the abdomen is distended
21
Q

What is the gold standard for diagnosing post-operative anastomotic leaks?

A

Contrast enhanced CT

22
Q

Management of post-operative peritonitis?

A
  • Fluid and electrolyte replacement
  • Nasogastric suction
  • Broad spectrum antibiotics
  • Consider need for reoperation
23
Q

Signs of SBP?

A
  • Fever
  • Abdominal pain
  • Rebound tenderness
  • Absent bowel sounds
  • Evidence of cirrhosis and ascites
24
Q

How is SBP diagnosed?

A
  • Diagnostic paracentesis
    • Cloudy fluid
    • Neutrophil count >250x106/L
  • Culture of fluid
25
Q

Most common cause of SBP?

A

Enteric E. coli

26
Q

Management of SBP?

A
  • Broad spectrum antibiotics
    • Cefotaxime
  • Recurrence risk reduced with prophylactin quinolones (ciprofloxacin)

Y4: Acute surgery (9 decks)

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