Peritonitis

• What are the RFs for peritonitis?

  Peritoneal dialysis

  GI perforation

  Abdominal surgery/trauma

  Cirrhosis with ascites

  Pelvic inflammatory disease

  Pancreatitis
• What are the signs & symptoms of peritonitis?

  Abdo pain

  Nausea

  Vomiting

  Loss of appetite

  Bowel disturbances

  Fever

  Tachycardia

  Hypotension

  Abdo distension

  Peritoneal signs (rebound tenderness, percussion tenderness, guarding)

  Bowel sounds -> may be absent or decreased
• What are the Inx for peritonitis?

  Obs

  Full Hx & examination

  Bloods (VBG/ABG, FBC, U&Es, LFTs, CRP, cultures, coag)

  Abdominal XR

  USS

  CT

  Paracentesis with analysis & culture

  Laparotomy (when diagnosis is uncertain or suspicion of surgical abdomen)
• What are the DDx of peritonitis?

  Gastroenteritis

  Pancreatitis

  Cholecystitis

  Appendicitis

  Diverticulitis
• What is the management of peritonitis?

  A-E approach

  IV fluids (crystalloids)

  Analgesia

  Bloods (FBC, U&Es, LFTs, coag, ABG/VBG, cultures)

  IV broad spec Abx

  Discuss with surgical reg -> surgery may be needed if perforation
• What are the possible complications of peritonitis?

  Sepsis

  Abscess

  Intra-abdominal adhesions

  Hepatic encephalopathy

  AKI