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Questions and Answers
What characterizes Primary/Spontaneous Bacterial Peritonitis?
Which condition is associated with Secondary Peritonitis?
What is a common symptom of peritonitis?
What is a potential cause of peritoneal dialysis-associated peritonitis?
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In the case of a 32-year-old female with tenderness and guarding in the right iliac fossa, what type of peritonitis is she likely experiencing?
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What laboratory test is specifically included to rule out pancreatitis during the diagnosis of peritonitis?
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Which imaging technique is best suited to identify free fluid in the abdomen without the use of contrast?
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In the context of microbiological investigations for peritonitis, what can cause failure to culture an organism?
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Which laboratory findings would most likely indicate inflammation/infection when diagnosing peritonitis?
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Which of the following types of specimens can be collected for microbiological investigation in cases of secondary peritonitis?
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What is the initial management step for a patient with peritonitis?
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Which antimicrobial combination is recommended for community-acquired secondary peritonitis?
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What is the role of metronidazole in the treatment of secondary peritonitis?
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Which of the following is a characteristic of piperacillin-tazobactam?
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What is the rationale for using gentamicin in secondary peritonitis management?
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In what scenario would adding an antifungal agent be considered in the treatment of secondary peritonitis?
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What type of bacteria does cefuroxime primarily target?
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Which option accurately describes a complication that may require supportive treatment in critical care for peritonitis patients?
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Which microorganisms should be covered in the empiric treatment of peritonitis?
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What initial step is crucial for managing secondary peritonitis?
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What is the purpose of sending a specimen of peritoneal fluid to microbiology?
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Which route of administration is typically used for empiric antimicrobials in primary peritonitis?
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In cases of suspected SBP, which procedure is necessary for diagnostic confirmation?
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What potential complication arises from bacterial peritonitis?
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What should be done if resistant microorganisms are identified after culture results are available?
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Which of the following is a correct statement regarding anaerobes in co-amoxiclav treatment?
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What is a common complication associated with peritonitis?
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Which type of peritonitis is most likely in a patient with alcoholic liver cirrhosis and ascites?
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Which organism is commonly found in peritoneal pus after perforation of a diverticulum?
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Which empirical antibiotic regimen is recommended for treating secondary peritonitis?
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What diagnostic procedure is essential for suspecting peritonitis?
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What is a key management strategy for peritonitis?
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Which condition does not fall under the categories of peritonitis?
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Why is anaerobic coverage necessary in managing secondary peritonitis?
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Study Notes
Peritonitis Classification
- Peritonitis can be primary (spontaneous bacterial peritonitis, aka SBP), secondary, or peritoneal dialysis (PD)-associated.
- SBP has no obvious source and may be seen in patients with pre-existing ascites (chronic liver disease).
- Secondary peritonitis is caused by intra-abdominal lesions/spillage like perforation of an organ, tumor, penetrating injury, acute pancreatitis, and post-procedure complications.
Peritonitis: Clinical Features
- Peritonism is the term for signs and symptoms of peritonitis.
- Symptoms include abdominal pain, bloating, feeling unwell, nausea/vomiting/anorexia.
- Abdominal pain may radiate to shoulders or back and worsen on movement.
- Fever is also common.
- Peritonitis can be localised or generalised.
Peritonitis: Diagnosis
- Diagnosis relies on clincial signs, laboratory testing (FBC, renal profile, liver function, coagulation, CRP, amylase, lactate, blood for group & save/cross-match, venous/arterial blood gas, procalcitonin), and microbiology.
- Expected findings include elevated CRP and WCC.
- Microbiology investigations include blood cultures, urine MC&S, and peritoneal fluid specimens.
- Radiology (abdominal X-ray (erect), CT scan, ultrasound) can be used to detect free air or fluid.
Peritonitis: Management
- Initial management focuses on bowel rest, large-bore IV cannula, analgesia, and IV fluids.
- Further management depends on clinical presentation - may require surgical exploration.
- Sepsis/septic shock requires supportive care in a critical care setting (oxygen, ventilation, inotropes, dialysis).
Management of Secondary Peritonitis
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Antimicrobials:
- Empiric choice depends on clinical scenario, likely microorganisms, and local guidelines.
- Community-acquired: 2nd generation cephalosporin (cefuroxime) + aminoglycoside (gentamicin) + metronidazole.
- Hospital-acquired: β-lactam/β-lactamase inhibitor combination (piperacillin-tazobactam) + aminoglycoside (gentamicin).
- Antifungal agent (caspofungin or fluconazole) may be recommended.
- Source control: Remove source of contamination by draining abscess, performing appendicectomy, bowel resection, or repairing perforation.
- If laparotomy is performed, peritoneal washout or ‘lavage’ is necessary. Specimen of fluid/faecal material should be sent promptly to microbiology.
Management of Primary Peritonitis (SBP) or PD Peritonitis
- Usually monomicrobial infection, but occult perforation (polymicrobial) should be excluded.
- Peritoneal fluid specimens are crucial for diagnosis.
- Treatment can be IV (SBP) or intraperitoneally (IP) via PD catheter.
- PD catheter may need removal or exchange.
Complications of Bacterial Peritonitis
- Bloodstream infection (BSI)
- Sepsis/septic shock
- Localised abscess/collection
- Adhesions - fibrous scar tissue forming abnormal attachments between organs.
- Adhesions can cause pain, volvulus, and intestinal obstruction.
Key Points
- Peritoneal fluid specimen is crucial for determining the causative microorganisms and their susceptibility.
- Empiric antimicrobial therapy should cover likely microorganisms and include anaerobic cover for secondary peritonitis.
- Once results are available, target/rationalise antimicrobial therapy based on susceptibility results.
- Failure to collect and send a peritoneal fluid specimen hinders appropriate management.
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Description
This quiz covers the classification, clinical features, and diagnosis of peritonitis. It focuses on understanding primary, secondary, and dialysis-associated peritonitis, along with the key symptoms and diagnostic methods. Perfect for medical students and healthcare professionals looking to enhance their knowledge in this area.
