Name
PERITONITIS
DESCRIPTION
DETAIL
CAUSES . Primary - spontaneous bacterial peritonitis . Ascites associated with cirrhosis, nephrotic syndrome . Secondary . Following abdominal trauma . Penetrating wounds . Continuous ambulatory peritoneal dialysis . Perforation of bowel . Appendicitis . Colitis - infectious, inflammatory . Peptic ulcer perforation . Gangrene of the bowel . Diverticulitis . Pancreatitis . Postoperative (intra-abdominal surgery) . Acute cholecystitis -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Abscess formation (subdiaphragmatic, subhepatic, peritoneal, pelvic) β’ Other causes of ileus (volvulus, intussusception) β’ Mesenteric adenitis β’ Appendicitis β’ PancreatitisLABORATORY β’ Positive culture of peritoneal aspirate β’ Leukocytosis β’ Increased BUN β’ Hemoconcentration β’ Positive blood culture β’ Metabolic acidosis β’ Respiratory acidosis β’ elevated amylase β’ Ascitic fluid analysis IMAGING β’ Abdominal fi lm: free air in peritoneal cavity, large bowel dilatation, small bowel dilatation, intestinal wall edema β’ Chest x-ray: elevated diaphragm β’ CT: intra-abdominal mass, ascites β’ Sonograph: intra-abdominal mass, ascites
TYPENOTES
RISK FACTORS: Recent surgery, Cirrhosis, frequently secondary to alcoholism, Corticosteroid medication, Nephrotic syndrome, Continuous ambulatory peritoneal dialysisGENERAL MEASURES β’ Treat paralytic ileus (nasogastric decompression) β’ Treat dehydration β’ Antibiotics are started empirically to cover a broad spectrum of organisms. The choice of antibiotic may be altered after culture results are obtained. β’ Respiratory support if needed β’ IV fluids β’ Blood transfusions (sometimes) SURGICAL MEASURES Treat underlying condition(s) and infection (by surgery if necessary) ACTIVITY Bedrest until infection is under control DIET β’ IV fluids and electrolytes β’ Oral feedings only after return of bowel sounds, and passage of flatus and/or feces β’ Total parenteral nutrition may be necessary DRUG(S) OF CHOICE . Spontaneous peritonitis . Ampicillin IV plus gentamicin . Third generation cephalosporin (ceftriaxone) . Ticarcillin-clavulanate, piperacillin-tazobactam, ampicillin-sulbactam . Secondary peritonitis : . Must cover against anaerobic organisms and gramnegative aerobic/facilitative organisms . Agents active against anaerobic organisms include cefoxitin, cefotetan, ticarcillin-clavulanate, piperacillintazobactam, ampicillin-sulbactam, imipenem . Associated with chronic ambulatory peritoneal dialysis . Vancomycin plus gentamicin instilled in peritoneal cavity ALTERNATIVE DRUGS β’ Antibiotics, other than those mentioned, if indicated by culture of blood or peritoneal fluid β’ Meperidine 50-100 mg IM PATIENT MONITORING Frequent monitoring acutely PREVENTION/AVOIDANCE Prophylactic antibiotics during abdominal surgery POSSIBLE COMPLICATIONS β’ Hypovolemic consequences β’ Septicemia β’ Septic shock β’ Acute renal failure β’ Acute respiratory insuffi ciency β’ Liver failure β’ Abscess formation EXPECTED COURSE/PROGNOSIS β’ Fully developed paralytic ileus requires 48 hours for recovery β’ Mortality dependent on - age, duration, cause, and on pre-existing conditions
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD SUGAR ( FASTING ), BLOOD UREA, SERUM AMYLASE, X-RAY ABDOMEN ERECT VIEW, ULTRA SOUND WHOLE ABDOMEN - FEMALE, BLOOD SUGAR ( AFTER MEALS ), BUN, COMPLETE BLOOD COUNT, CT SCAN ABDOMEN