Peritonitis

Question 1

What is peritonitis?

1 - inflammation of peri-anal area
2 - inflammation of the parenchyme of the liver
3 - inflammation of the peritoneum

Answer 1

3 - inflammation of the peritoneum

• peritoneum is a membrane, a sheet of smooth tissue that lines your abdominopelvic cavity and surrounds your abdominal organs.

Question 2

If a patient has peritonitis, but is correctly treated surgically, what is the mortality rate?

1 - 1%
2 - 5%
3 - 10%
4 - 35%

Answer 2

3 - 10%

Question 3

If a patient has peritonitis, and they develop sepsis, what is the mortality rate?

1 - 1%
2 - 5%
3 - 10%
4 - 35%

Answer 3

4 - 35%

Question 4

If a patient has spontaneous bacterial peritonitis, what is the mortality rate?

1 - 1-5%
2 - 5-10%
3 - 10-15%
4 - 35-40%

Answer 4

3 - 10-15%

Question 5

If a patient has had peritonitis previously, what is the reoccurrence rate?

1 - 5%
2 - 10%
3 - 15%
4 - 70%

Answer 5

4 - 70%
- in one year

Question 6

Peritonitis is an inflammation of the peritoneum, which is a membrane that lines the abdominopelvic cavity and wraps around some organs. How does it generally begin?

1 - local inflammation of abdominal viscus
2 - local inflammation of the omentum
3 - systemic inflammation of all viscera
4 - systemic inflammation of all mesenteries

Answer 6

1 - local inflammation of abdominal viscus

• viscus is singular for visceral, which means internal organs of the cavities

Question 7

In peritonitis is the initial pain well localised?

Answer 7

• no
• once parietal peritoneum is involved pain become localised to viscus affected
• can become worse if abdominal muscles are engaged

Question 8

Is peritonitis generally present in most GI diseases/conditions?

Answer 8

• yes

Question 9

If the local peritoneum is insufficient at containing the infection or local cause of peritonitis, what can happen?

1 - viscus affected can become ischaemic and die
2 - generalised peritonitis occurs
3 - all organs in the abdomen become affected
4 - patient will become septic

Answer 9

2 - generalised peritonitis occurs

Question 10

What is an abscess?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

Answer 10

4 - pus filled collection lined by granulation tissue

• generally contains dead tissue, neutrophils, exudate (high protein and LDH)

Question 11

What is a cyst?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

Answer 11

1 - sac filled with fluid or other material lined by epithelial cells

Question 12

What is an pseudocyst?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - pus filled collection lined by granulation tissue

Answer 12

2 - fluid filled area lined by granulation tissue

Question 13

What is a fistula?

1 - opening lines by granulation tissues
2 - abnormal passageway, or tunnel, in the body, usually both lines by epithelial cells
3 - abnormal passageway, or tunnel, in the body, usually both lines by granulation tissue

Answer 13

2 - abnormal passageway, or tunnel, in the body, usually both lines by epithelial cells

Question 14

What is a sinus?

1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection lined by epithelial cells
4 - blind ended tract

Answer 14

4 - blind ended tract

Question 15

What is an ascites?

1 - fluid filled abscess
2 - fluid filled cyst
3 - fluid filled space in the abdomen
4 - fluid filled organs

Answer 15

3 - fluid filled space in the abdomen

Question 16

What is the most common cause of peritonitis?

1 - abscess
2 - cyst
3 - pseudocyst
4 - fistula

Answer 16

1 - abscess

• can be due to omentum trying to wall off infection
• various perforations (appendicitis, diverticulitis, gall bladder, GIT, malignancy or ischaemic bowel)

Question 17

Is generalised peritonitis, which is generally due to infection or chemical irritation due to leakage of bowel contents, dangerous?

Answer 17

• yes

Question 18

Generalised peritonitis, which is generally due to infection or chemical irritation due to leakage of bowel contents is very dangerous and can lead to bacterial infection. Which 2 bacteria are the most common cause?

1 - E.coli and Klebsiella
2 - E.coli and Bacteroides
3 - Bacteroides and Klebsiella
4 - Streptococcus and E.coli

Answer 18

2 - E.coli and Bacteroides

Question 19

What is primary peritonitis

1 - inflammation of the whole peritoneum
2 - inflammation of peritoneum with no clear intra-abdominal source
3 - inflammation of greater omentum
4 - inflammation of visceral peritoneum

Answer 19

2 - inflammation of peritoneum with no clear intra-abdominal source

• rare but generally due to infection of ascitic fluid in liver disease caused by streptococcus

Question 20

Which of the following are NOT a common symptom of peritonitis?

1 - anorexia
2 - fever
3 - severe generalised abdominal pain radiating to shoulders and back
4 - abdominal pain worse with movement
5 - coughing
6 - melena
7 - sneezing

Answer 20

6 - melena

Question 21

Which of the following is NOT a common sign of peritonitis?

1 - fever
2 - tachycardia
3 - increased BP
4 - generalised abdominal tenderness with guarding, rigidity, rebound tenderness
5 - swinging pyrexia

Answer 21

3 - increased BP

Question 22

If peritonitis moves from local to generalised peritonitis, does the patients condition get better or worse?

Answer 22

• declines rapidly

Question 23

If a patient has secondary peritonitis, secondary due to perforation, which of the following is NOT a common sign?

1 - sudden onset of acute and severe abdominal pain
2 - gradual increase in pain and distention
3 - collapse of the patient
4 - patient goes into shock

Answer 23

2 - gradual increase in pain and distention

Question 24

If a patient has swinging pyrexia (moves between chills and fever) in suspected peritonitis, what can this suggest?

1 - abscess or pyogenic infection
2 - abscess or cyst
3 - pyogenic infection or cyst

Answer 24

1 - abscess or pyogenic infection

• neutrophils are released but then destroyed

Question 25

Is secondary peritonitis as dangerous as primary peritonitis?

Answer 25

- no - symptoms gradually become worse

Question 26

Peritonitis can cause pneumoperitoneum. What imaging modality is best to detect the presence of pneumoperitoneum? 1 - erect chest X-ray 2 - supine chest X-ray 3 - erect MRI scan 4 - erect CT scan

Answer 26

1 - erect chest X-ray - air will rise to the above the liver

Question 27

For a definitive diagnosis of peritonitis, what 2 imaging modalities are most commonly used? 1 - CT and MRI 2 - ultrasound and MRI 3 - ultrasound and X-ray 4 - CT and ultrasound

Answer 27

4 - CT and ultrasound

Question 28

When assessing for peritonitis we need to take bloods. Which of the following is NOT typically raised during peritonitis? 1 - Hb and WCC 2 - CRP 3 - U+Es 4 - amylase 5 - clotting factors 6 - LFTs 7 - bilirubin 8 - group and save (determines patient blood group)

Answer 28

7 - bilirubin

Question 29

If a patient has peritonitis and we suspect ischaemic bowel or pancreatitis, what blood test must we do? 1 - CRP 2 - WCC 3 - ABG 4 - neutrophils

Answer 29

3 - ABG

Question 30

If a patient has suspected bacterial peritonitis, what raised marker in blood is generally enough to begin treatment? 1 - RBCs 2 - neutrophils 3 - WCC 4 - leukocytes

Answer 30

2 - neutrophils

Question 31

If a patient has peritonitis and an abscess has been identified as the cause and is accessible on a CT or ultrasound, what treatment would the patient be given? 1 - ultrasound guided percutaneous drainage 2 - laparotomy and abscess drainage 3 - percutaneous drainage if palpable 4 - fluids and rest

Answer 31

1 - ultrasound guided percutaneous drainage - if unable to drain percutaneously then patient will need a laparotomy to drain the abscess and treat underlying cause

Question 32

In generalised peritonitis the patient is at risk of sepsis. Which of the following is NOT a treatment for patients who becomes septic? 1 - give IV fluid and put in catheter to monitor fluids 2 - prescribe antibiotics (metronidazole + cefuroxime) 3 - place patient on air and measure lactate levels 4 - take blood sample for blood cultures 5 - encourage the patient to eat for calories due to stress

Answer 32

5 - encourage the patient to eat for calories due to stress - patient may also be placed on an NG tube

Question 33

If a patient has generalised peritonitis and requires surgery via laparotomy, which of the following is NOT a treatment? 1 - partial dissection of pancreas as underlying cause 2 - peritoneal and abdominal cavity lavage 3 - treatment of underlying condition (appendicitis etc.)

Answer 33

1 - partial dissection of pancreas as underlying cause

Question 34

If a patient has generalised peritonitis and requires surgery for initial diagnosis, is laparotomy or laparoscopy preferred?

Answer 34

- laparoscopy - minimises wound complications and more rapid recovery

Question 35

If a patient has suspected peritonitis following surgery and presents with swinging pyrexia, high WCC and continued pain) what should we suspect for? 1 - local abscess formation 2 - local ascities 3 - perforation 4 - local cyst formation

Answer 35

1 - local abscess formation - commonly pelvis or subphrenic