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Questions and Answers
What characterizes Primary/Spontaneous Bacterial Peritonitis?
What characterizes Primary/Spontaneous Bacterial Peritonitis?
Which condition is associated with Secondary Peritonitis?
Which condition is associated with Secondary Peritonitis?
What is a common symptom of peritonitis?
What is a common symptom of peritonitis?
What is a potential cause of peritoneal dialysis-associated 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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
Which microorganisms should be covered in the empiric treatment of peritonitis?
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What initial step is crucial for managing secondary peritonitis?
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?
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?
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?
In cases of suspected SBP, which procedure is necessary for diagnostic confirmation?
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What potential complication arises from bacterial peritonitis?
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?
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?
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?
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?
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?
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?
Which empirical antibiotic regimen is recommended for treating secondary peritonitis?
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What diagnostic procedure is essential for suspecting peritonitis?
What diagnostic procedure is essential for suspecting peritonitis?
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What is a key management strategy for peritonitis?
What is a key management strategy for peritonitis?
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Which condition does not fall under the categories of peritonitis?
Which condition does not fall under the categories of peritonitis?
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Why is anaerobic coverage necessary in managing secondary peritonitis?
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
-
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.
