Peritonitis

Steven Podnos MD

Definition

• Inflammation/Infection of the Peritoneal cavity

• Main types: Post perforation of abdominal organ or SBP

SBP

• Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source; it primarily occurs in patients with advanced cirrhosis

• diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count ≥250 cells/mm3.

SBP

• The main indication for empiric therapy is the otherwise unexplained presence of one or more of the following findings that are characteristically seen in SBP (table 2):

• Temperature greater than 37.8ºC (100ºF) • Abdominal pain and/or tenderness • A change in mental status • Ascitic fluid PMN count ≥250 cells/mm3

Surgical Abdomen• Surgical abdomen — The first diagnoses that must be considered in

patients with acute abdominal pain are those that may require urgent surgical intervention. The 'surgical abdomen' can be usefully defined as a condition with a rapidly worsening prognosis in the absence of surgical intervention [20]. Two syndromes that constitute urgent surgical referrals are obstruction and peritonitis. The latter encompasses most severe abdominal pathology since intraperitoneal hemorrhage or viscus perforation typically present with common features of peritonitis.

• Patients with acute surgical abdomens will often have a rapid symptom evolution, but patients who have evolved from partial to complete bowel obstruction may present with weeks of vague abdominal pain, followed by a sudden deterioration. Pain is typically severe in all of these conditions, and it can be associated with unstable vital signs, fever, and dehydration.

Peritonitis-signs

• Look sick• Lie Still• Rebound tenderness, also consider abdominal

rigidity and heightened direct tenderness (stretcher bump sign)

• Often diminished bowel sounds

Peritonitis-Rx

• Unless SBP• Surgical evaluation ASAP• Lab and Radiology adjunctive to surgical

opinion

Peritonitis-CPD

• Usually skin organisms• Rarely develop systemic bacteremia as is

more common with SPD and Surgical Peritonitis

• Tend to be subacute exit tract infections• Preventive regimens some cases• Antibiotic Rx variable/catheter removal