Peritonitis (Acute Abdomen, Surgical Abdomen)

Last updated 03.11.12

 

Index

 

Definition

-  Peritonitis = inflammation of peritoneum

-  Acute abdomen = unDx abdo pain of <1/52

 

Features

-  Clinical Dx

-  Surgical emergency

 

Associated S/S

-  Shock: septic, high output

-  Abdominal pain +/- distension

-  Abdominal guarding, rigidity, rebound tenderness

-  Rosvings sign, Obturator sign, Psoas sign, RIF pain: Appendicitis

-  RUQ pain, Murphys sign, biliary colic: Cholecystitis

-  Board like rigidity, severe pain, sudden onset: PUD perforation

-  Constant LIF pain, mass: Diverticulitis

-  Central pain, radiation to back: Pancreatitis

-  Colicky pain, vomiting: Bowel Obstruction

-  Pulsatile abdo mass: AAA

 

Causes

-  Perforation

-  Perforated PUD

-  Transmural inflammation

-  Hollow viscus injury

-  Diverticulitis

-  Appendicitis

-  Cholecystitis

-  Pancreatitis

-  Bowel Obstruction

-  Post-op

-  Chemical

-  Blood borne

-  Strangulated/infarcted bowel

-  Intrabdominal Abscess

 

Ix

-  Abdo Exam

-  Vitals

-  Temp: Fever

-  BP, HR: shock, sepsis

-  FBE

-  WBC

-  U&E

-  Urea, Cr: hypovolaemia

-  LFTs: cholestatic picture: cholecystitis

-  Erect + supine AXR + erect CXR: Pneumoperitoneum

 

Mx

-  Surgical R/V

-  Mx of underlying cause

-  IV fluids

-  +/- NGT

-  IV Abx

-  +/- intubation or O2

-  Analgesia

 

 

 

References