Peritonitis

Question 1

Description: What is peritonitis?

Answer 1

• Inflammation of the peritoneum (acute abdomen)

Question 2

Aetiology/ Risk Factors: What causes peritonitis?

Answer 2

• Infection

Question 3

Pathology: What are the possible routes of infection in peritonitis? (4)

Answer 3

Routes of infection:

• Perforation of GI/biliary tract
• Female genital tract
• Penetration of abdominal wall
• Haematogenous spread

Question 4

Pathology: Why does generalised peritonitis occur? (3)

Answer 4

Generalised peritonitis occurs because:

• Contamination is too fast
• The contamination is persistent
• Abscess ruptures

Question 5

Symptom: What are the symptoms of peritonitis? (6)

Answer 5

• Abdominal pain
• Bloating
• Diarrhoea
• Fever
• Fatigue
• Nausea and Vomiting

Question 6

Signs: AAA

Answer 6

AAA

Question 7

Investigations: What investigations do we perform for an acute abdomen (peritonitis)

(a) Ward tests (2)
(b) Blood tests (3)
(c) Imaging (3)

Answer 7

(a) Ward tests (urine and serum hCG are vital to exclude ectopic pregnancy)
(b) Blood tests (FBC, U+E, LFTs)
(c) Imaging (ultrasound, CT, erect chest x-ray)

Question 8

Treatment: How do we manage a patient with acute abdomen (peritonitis)?

Answer 8

• Assess (+ resuscitate)
• Investigate
• Observe
• Treat (pain relief, antibiotics and definitive interventions such as surgery)

Question 9

Complications: What are the effects of peritonitis and obstruction? (2)

Answer 9

• Fluid loss and SEPSIS

- These can lead to circulatory collapse and eventually DEATH

Question 10

Extra: What are the 2 types of peritonitis? (2)

Which one is more severe?

Answer 10

2 types of peritonitis:

• Localised peritonitis
• Generalised peritonitis

(Generalised peritonitis is more severe than localised peritonitis)

Question 11

Extra: Anaerobes mainly live in what organ? (peritonitis)

Answer 11

• Anaerobes mainly live in the colon

Question 12

Extra: What is the difference between somatic pain and visceral pain? (peritonitis)

Answer 12

Visceral pain vs somatic pain

- Somatic pain is localised, while visceral pain is not

Question 13

Extra: When assessing a patient with acute abdomen (peritonitis), what do we consider? (5)

Answer 13

Assessment of the patient:

• Problem?
• Effect?
• What’s to be done?
• Capacity
• Level of care needed

Question 14

Extra: What is to be done for the patient during resuscitation (peritonitis)? (6)

Answer 14

Resuscitation:

• Ensure tissue perfusion
• Enhance tissue oxygenation
• Ensure pain relief
• Treat sepsis
• Restore circulating fluid volume
• Decompress the gut