Peritonitis: Difference between revisions
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* Inflammation of serosal membrane lining abdominal cavity and intraabdominal organ | * Inflammation of serosal membrane lining abdominal cavity and intraabdominal organ | ||
* Infectious or sterile (mechanical, chemical) | * Infectious or sterile (mechanical, chemical) | ||
* Primary: Hematogenous, | * Primary: Hematogenous, [[spontaneous bacterial peritonitis]] (SBP) | ||
* Secondary: Perforation or trauma, most common | * Secondary: Perforation or trauma, most common | ||
* Tertiary: Persistent/recurrent infection | * Tertiary: Persistent/recurrent infection | ||
==Clinical Features== | ==Clinical Features== | ||
* Abdominal pain or discomfort | * [[Abdominal pain]] or discomfort | ||
* Abdominal distention, wall tenderness, rigidity | * Abdominal distention, wall tenderness, rigidity | ||
* Anorexia and nausea | * Anorexia and [[nausea]] | ||
* Guarding or rebound | * Guarding or rebound | ||
* Sepsis | * [[Sepsis]] | ||
* Signs of liver failure | * Signs of [[liver failure]] | ||
* Spontaneous | * [[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 | ||
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* Chronic peritoneal dialysis | * Chronic peritoneal dialysis | ||
* Neoplasm | * Neoplasm | ||
* Pyelonephritis | * [[Pyelonephritis]] | ||
* Empyema | * [[Empyema]] | ||
* Rectus hematoma | * Rectus hematoma | ||
* Intestinal incarceration, hernia | * Intestinal incarceration, [[hernia]] | ||
* Appendicitis | * [[Appendicitis]] | ||
* Mesenteric ischemia | * [[Mesenteric ischemia]] | ||
* Abdominal aneurysm | * [[Abdominal aneurysm]] | ||
==Workup== | ==Workup== | ||
* Clinical diagnosis | * Clinical diagnosis | ||
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* US, CT a/p | * US, CT a/p | ||
* Diagnostic paracentesis to r/o SBP: PMN ≥ 250 cells/mm³ | * Diagnostic paracentesis to r/o SBP: PMN ≥ 250 cells/mm³ | ||
==Management== | ==Management== | ||
* Fluid resuscitation | * Fluid resuscitation | ||
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* Surgical consult | * Surgical consult | ||
* IR consult: Abscess drainage | * IR consult: Abscess drainage | ||
==See Also== | ==See Also== | ||
*[[Abdominal pain]] | |||
==External Links== | ==External Links== | ||
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<references/> | <references/> | ||
Daley BJ, et al. (2014, Sep 25). Peritonitis and Abdominal Sepsis. eMedicine. Retrieved 12/25/2014 from http://emedicine.medscape.com/article/180234-overview | Daley BJ, et al. (2014, Sep 25). Peritonitis and Abdominal Sepsis. eMedicine. Retrieved 12/25/2014 from http://emedicine.medscape.com/article/180234-overview | ||
[[Category:GI]] | |||
Revision as of 04:26, 28 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