Peritonitis

Question 1

Define Peritonitis

Answer 1

Inflammation in the peritoneal cavity

Question 2

What is the peritoneum and peritoneal cavity?

Answer 2

• 2 serous membranes consisting of the parietal (cavity wall) peritoneum & visceral (organs) peritoneum
• Seperates the abdo. cavity from abdo. wall
• The peritoneal cavity is the space between the 2 serous membrances

Question 3

What is a serous membrane and what is it’s function?

Answer 3

Consists of;

• Epithelial layer (mesothelium)
  
  • Simple squamous epithelium which produce lubricating serous fluid
• Connective tissue layer
  
  • Blood vessels & nerves
  • Binding layer

Question 4

What is the function of serous fluid?

Answer 4

Reduces friction

Question 5

What does the term ‘mesentery’ mean?

Answer 5

• A double fold of peritoneum
• Classically
  
  • Connection of jejunum & ileum

Question 6

Draw a lateral schematic of the peritoneum (inc. greater & lesser sac & greater & lesser omentum)

Answer 6

Question 7

What are the causes of peritonitis?

Answer 7

• Primary - rare
  
  • Typ. streptococcal via bloodstream > intra-abdo. organs
• Secondary - common, perforated;
  
  • Appendicitis (under 45s)
  • Diverticular disease (elderly)
  • Upper GI
  • Tumours
  • Ischaemic bowel (due to adhesions)
• Peritoneal dialysis-related (via contaminated diaysate bags/ cathetar)
• Post surgical intervention (anastomotic leak, enteric injury)

Question 8

What are the symptoms of peritonitis?

Answer 8

• Anorexia & fever
• Severe generalized abdomincal pain radiating to shoulders and back
• Abdominal pain worse with movement, coughing, sneezing

Question 9

What are the signs of peritonitis?

Answer 9

• Fever & tachycardia
• Generalized abdominal tenderness with guarding and rigidity
• Gentle palpation may allow identification of an underlying mass

Question 10

How is a diagnosis made?

Answer 10

• Clinical manifestations mainly
• Leukocytosis, hyokalemia, hypernatremia & acidosis may be present
• X-Ray - dilated, edematous intestines (& pneumoperitoneum [GI perforaton])
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