Peritonitis
Revision as of 04:26, 28 December 2014 by Rossdonaldson1 (talk | contribs)
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