Peritonitis

Question 1

Features of Spontaneous bacterial peritonitis

Answer 1

• ascites
• abdo pain
• fever

Question 2

What investigation findings would indicate Spontaneous bacterial peritonitis

Answer 2

• paracentesis: neutrophil count > 250 cells/ul
• ascitic fluid culture - mc E. coli

Question 3

Management of Spontaneous bacterial peritonitis

Answer 3

intravenous cefotaxime

Question 4

When should patients be given antibiotic prophylaxis for spontaneous bacterial peritonitis

Answer 4

patients with ascites if:
* had an episode of SBP
* fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome

Question 5

What prophylactic antibiotics are offered against spontaneous bacterial peritonitis

Answer 5

oral ciprofloxacin or norfloxacin

Question 6

Give at least 3 causes of secondary peritonitis

Answer 6

• perforated peptic ulcer
• ruptured appendicitis
• diverticulitis
• GI tract perforations secondary to trauma or neoplasia.

Question 7

Clinical presentation of secondary peritonitis

Answer 7

• acute severe abdo pain, localised to the site of underlying pathology
• may become more diffuse as inflammation spreads
• fever
• tachycardia
• rebound tenderness and guarding

Question 8

How is secondary peritonitis managed

Answer 8

• surgical intervention
• broad spectrum antibiotics