peritonitis - clinical features

when should peritonitis be suspected?

when a pt presents with acute, severe abdominal pain

what other features may the patient present with? (4)

- fever

- nausea

- vomiting

- systemic upset (e.g. tachycardia, hypotension)

what other symptoms could the patient mention? (4)

- pain worse on movement

- abdominal distension

- anorexia

- sweating

what are the 2 types of pain possible for peritonitis?

- localised

- generalised

what causes the generalised pain?

initial inflammation of visceral peritoneum

what causes localised pain?

inflammation of the parietal peritoneum

what are the signs of peritonitis? (9)

- tenderness on palpation

- guarding

- rigidity

- rebound tenderness

- fever

- tachycardia

- absent/reduced bowel sounds

- inflammatory mass

- features of septic shock

what are the features of septic shock? (4)

- hypotension

- oliguria/anuria

- confusion

- mottled skin

what does mottled skin look like?

what is oliguria?

low urine output

what is anuria?

no urine output

what organs commonly cause peritonitis? (6)

- oesophagus

- stomach

- pancreas

- liver + gall bladder

- small intestines

- colon

how can the oesophagus cause peritonitis? (3)

- trauma

- rupture (boerhaave syndrome)

- malignancy perforation

what is boerhaave syndrome?

transmural oesophageal rupture due to violent vomiting (Boerhaave = been-heaving)

what is the difference between boerhaave and mallory-weiss syndromes?

mallory weiss - mucosal tear

boerhaave - transmural tear

how can the stomach cause peritonitis? (2)

- peptic ulcer perforation

- malignancy perforation

how can the pancreas cause peritonitis?

pancreatitis

how can the liver + gallbladder cause peritonitis? (3)

- malignancy perforation

- gallstones

- cholecystitis

how can the small intestines cause peritonitis? (2)

- ischaemic bowel

- strangulated hernias

- duodenal ulcers

how can the colon cause peritonitis? (3)

- appendicitis

- diverticulitis

- colorectal cancer

what happens when these structures from the GI tract rupture?

GI tract content spills and allows entry of bacteria into previously sterile compartment