Peritonitis: Difference between revisions
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* Tertiary: Persistent/recurrent infection | * Tertiary: Persistent/recurrent infection | ||
==Clinical Features== | ==Clinical Features== | ||
* Abdominal pain | * Abdominal pain or discomfort | ||
* Abdominal | * Abdominal distention, wall tenderness, rigidity | ||
* Anorexia and nausea | * Anorexia and nausea | ||
* Guarding or rebound | |||
* Sepsis | |||
* Signs of liver failure | |||
* Spontaneous Bacterial Peritonitis | * Spontaneous Bacterial Peritonitis | ||
** Fever and chills | ** Fever and chills | ||
* Abdominal pain or discomfort | ** Abdominal pain or discomfort | ||
* Worsening or unexplained encephalopathy | ** Worsening or unexplained encephalopathy | ||
* Diarrhea | ** Diarrhea | ||
* Ascites | ** Ascites | ||
* Worsening or new-onset renal failure | ** Worsening or new-onset renal failure | ||
* Ileus | ** Ileus | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Perforation | * Perforation | ||
Revision as of 06:25, 26 December 2014
Background
- Inflammation of serosal membrane lining abdominal cavity and intraabdominal organ
- Infectious or sterile (mechanical, chemical)
- Primary: Hematogenous, Spontaneous bacterial peritonitis (SBP)
- Secondary: Perforation or trauma, most common
- Tertiary: Persistent/recurrent infection
Clinical Features
- Abdominal pain or discomfort
- Abdominal distention, wall tenderness, rigidity
- Anorexia and nausea
- Guarding or rebound
- Sepsis
- Signs of liver failure
- Spontaneous Bacterial Peritonitis
- Fever and chills
- Abdominal pain or discomfort
- Worsening or unexplained encephalopathy
- Diarrhea
- Ascites
- Worsening or new-onset renal failure
- Ileus
Differential Diagnosis
- Perforation
- Chronic peritoneal dialysis
- Neoplasm
- Pyelonephritis
- Empyema
- Rectus hematoma
- Intestinal incarceration, hernia
- Appendicitis
- Mesenteric ischemia
- Abdominal aneurysm
Workup
- Clinical diagnosis
- CBC (leukocytosis), chem, coags, albumin
- Other test: LFT, lipase, UA, Stool sample
- Abdominal Xray (supine, upright, lateral decubitus)- free air?
- US, CT a/p
- Diagnostic paracentesis to r/o SBP: PMN ≥ 250 cells/mm³
Management
- Fluid resuscitation
- Systemic antibiotics
- Surgical consult
- IR consult: Abscess drainage
See Also
External Links
Sources
Daley BJ, et al. (2014, Sep 25). Peritonitis and Abdominal Sepsis. eMedicine. Retrieved 12/25/2014 from http://emedicine.medscape.com/article/180234-overview