Peritonitis

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
• Abdominal distension
• Anorexia and nausea
• Spontaneous Bacterial Peritonitis
  • Fever and chills
• Abdominal pain or discomfort
• Worsening or unexplained encephalopathy
• Diarrhea
• Ascites
• Worsening or new-onset renal failure
• Ileus
• Abdominal wall rigidity, abdominal wall tenderness
• Guarding or rebound
• Sepsis
• Signs of liver faliure

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

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