8. Appendicitis & Peritonitis
What are the clinical manifestations of Peritonitis?
- Abdominal pain* - Worsening encephalopathy (altered mental status) - Worsening or new onset renal failure - Rigidity - Abdominal distention - Fever, chills, fatigue
What is Spontaneous Bacterial Peritonitis (SBP)?
- Acute bacterial infection of ascitic fluid - *No source of infection* - Common in people with chronic liver disease
What are the clinical manifestations of Appendicitis?
- Anorexia - Periumbilical/epigastric pain followed by RLQ pain & nausea/vomitting
What is the treatment for Appendicitis?
- Appendectomy - NPO
What diagnostic tests are indicated for Appendicitis?
- CT - Ultrasound - CBC: Leukocytosis (↑ WBC)
What physical exam findings are consistent with Appendicitis?
- McBurney's point tenderness - Rovsing Sign - Rebound Tenderness - Obturator Sign - Psoas Sign
What is Secondary Peritonitis (SP)?
- Sources of infection leading to peritonitis - Infected ascites fluid due to an underlying *surgically treatable source of infection* → Perforated viscus → Peritoneal dialysis → Pancreatitis → Trauma
What is the treatment for Peritonitis?
1. Antibiotics 2. IV albumin 3. Correction of the underlying process 4. Supportive therapy
What are the 2 major types of Peritonitis?
1. Spontaneous Bacterial Peritonitis (SBP) 2. Secondary Peritonitis (SP)
What diagnostic tests are indicated for Peritonitis?
Abdominal paracentesis
What is Peritonitis?
Inflammation of the serosal membrane that lines the abdominal cavity and the organs contained within
What is Appendicitis?
Inflammation, Obstruction of the appendix
What is the etiology of Appendicitis?
Obstruction - Lymphoid hyperplasia - Fecaliths - Tumors/neoplasm - Foreign body
How can you differentiate Spontaneous Bacterial Peritonitis (SBP) from Secondary Peritonitis (SP)?
Paracentesis Findings: Spontaneous Bacterial Peritonitis (SBP) - Responds to tx (↓ PMN) at 48hrs Secondary Peritonitis (SP) - Up to 2/3 of patients have at least 2 of the following: → Decreased glucose (< 50mg/dL) → Elevated LD (> serum) → Total protein > 1 g/dL - Anaerobes
What are the complications of Appendicitis?
Perforation - Pain > 36 hours, diffuse abd tenderness or *peritoneal signs*
