Secondary Peritonitis

Question 1

What is defined as inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs.

Answer 1

Peritonitis

Question 2

Typically, when someone says peritonitis, they are usually referring to what?

Answer 2

secondary peritonitis.

Question 3

Primary vs Secondary Peritonitis
There is inflammation of the peritoneal surface without another intra-abdominal process.
1) Also known as Spontaneous Bacterial Peritonitis (SBP)
2) Less common; usually associated with ascites

Answer 3

Primary Peritonitis

Question 4

Primary vs Secondary Peritonitis
Develops as a result of inflammation of another intra-abdominal structure or in association with another intra-abdominal disease process

Answer 4

Secondary Peritonitis

Question 5

Pertinent Anatomy
What lines the outer portions of all intra-abdominal organ surfaces that are within the peritoneal cavity

Answer 5

Visceral Peritoneum

Question 6

Pertinent Anatomy
What lines the interior portion of the abdominal wall (lines the peritoneal space)

Answer 6

Parietal Peritoneum

Question 7

Pertinent Anatomy:
What is the space posterior to the posterior parietal peritoneal membrane

Answer 7

Retroperitoneal Space

Question 8

What are the most common causes of acute peritonitis:

Answer 8

(a) Perforated Appendicitis
(b) Perforated Diverticulitis
(c) Pancreatitis

Question 9

In female patients, be sure to assess for what regardless of stated sexual and medical history?

Answer 9

pregnancy and ectopic pregnancy

Question 10

True/False
Pregnant Until Proven Otherwise

Answer 10

True

Question 11

What issues
Patient presenting
1) very ill appearing
2) unstable vital signs; Fever and tachycardia
(a) Fetal position or supine with legs bent (typically will say they feel better laying on back with pillow under knees).
(b) Patients typically do NOT want to move (contrast with obstructive type symptoms).
(c) Percussion: Absence of dullness over the liver suggests free air/perforation.
(d) Palpation: Begin with light palpation away from the area of maximal symptoms; board-like abdomen
(e) Auscultation: May have absence of bowel sounds in all 4 quadrants: not very sensitive of specific!

Answer 11

Secondary Peritonitis

Question 12

All patients with suspected peritonitis need….

Answer 12

antibiotics

Question 13

If the etiology of the peritonitis is not clear, what type of antibiotics would be sufficient until the source of their infection is identified?

Answer 13

broad spectrum IV antibiotics that have gram negative and anaerobic bacterial coverage

Question 14

True/False
All patients with diffuse peritonitis should have two large bore IVs (16-18 gauge) in the event they acutely decompensate.

Answer 14

True

Question 15

Management and Treatment: Secondary Peritonitis

Answer 15

1) Antibiotics
-if etiology of the peritonitis is not clear, broad spectrum IV antibiotics
2) IV Fluids and NPO
-diffuse peritonitis should have two large bore IVs
3) Morphine 1-10mg IV q4 hours for pain

Question 16

Disposition: Secondary Peritonitis
(1) MEDEVAC is always necessary for diffuse peritonitis or peritonitis of unknown origin.
(2) A minimum of ______ is necessary for localized peritonitis, but they will likely need a MEDEVAC.
(a) Example: Mild uncomplicated diverticulitis may not need a MEDEVAC.
(3) _____ consultation

Answer 16

1) MEDEVAC
2) MEDVICE
3) General Surgery