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Acute Peritonitis (Signs & symptoms (Main symptom is usually pain.…
Acute Peritonitis
Signs & symptoms
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Patients usually lie still with knees bent and head raised (this diminishes the tension of the abdominal wall, alleviating pain)
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Pathophysiology
Post operative peritonitis. May be a compilation of surgery (e.g. anastomotic leakage) or a residual of the presenting complaint
Secondary peritonitis - an infection that results from an inflammation or mechanical break of the integrity of the intestinal or the urogenital tract or solid organs, thereby exposing the peritoneal cavity to the resident flora of the GI tract
Primary peritonitis/Spontaneous Bacterial Peritonitis. Most commonly seen in patients with liver cirrhosis (ascites) or chronic renal failure (especially those on peritoneal dialysis). Mortality rate in this group 20-80%
The total surface area of the peritoneum is approx. 17.m2. In normal conditions it is sterile and contains approx. 50mls of fluid.
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Definition
Inflammation of the peritoneum, the tissue that lines the abdominal cavity and covers most of the abdominal organs
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IV antibiotics
IV fluids
catheter
prompt surgical intervention of underlying cause, (repair of perforated viscus, infarcted bowel resected, infective focci removed or drained).
Bloods - raised inflammatory markers
or raised amylase to suggest pancreatitis. Lactate as part of sepsis 6
Abdominal CT can reliably exclude pancreatitis and often locate the source of pathology.
Laparoscopy is useful in cases where laparotomy should be avoided
Chest X-ray to detect perforation
infection entering via bloodstream
may occur secondary to nephrotic syndrome, more commonly cirrhosis/ascites.
perforated appendicitis
perforated diverticular disease
upper GI perforation
perforated tumours (colon/gastric)
perforated ischaemic bowel
acute pancreatitis
post op (anastomotic leak, enteric injury)
peritoneal dialysis - bacteria entering via contaminated equipment.
Aseptic peritonitis - bile, gastric contents, blood) and is frequently followed by secondary bacterial peritonitis.
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Oronez, CA., Puyana, JC., 2006. Managment of Peritonitis in the Critically Ill Patient. Surgical Clinics of North America [online]. 86(6), pp1323-1349. [viewed on 3 May 2019). Available from:https://doi.org/10.1016/j.suc.2006.09.006Garden & Parks. Principles & practice of surgery 2018Oxford Handbook of Clinical Surgery. 4th edition. 2012