Peritonitis and Ascites

What might you find in an abdo exam of a patient with peritonitis?

Abdo guarding, lying V. ridged, silent abdomen-ominous sign

PC of peritonitis?

Acute Pain; Tenderness; Localised - progression to generalised; Systemic symptoms: Nausea, chills and rigor; Dizziness, Weakness and inability to move due to pain

What lab tests would you run on ascetic fluid?

Chemistry: Proteins, Serum Ascites Albumin Gradient [SAAG], total protein, triglycerides and Amylase; Micro: Microscopy, Cytology and Organisms Culture

Main causes of ascites?

Cirrosis, pancreatitis, heart failure, malignancy, TB,

What is ascites?

Effusion and accumulation of serous fluid in the abdominal cavity

Cause of Primary Peritonitis?

Extremely rare!!! Cause haematogenous or lymph nodes; Risk groups- Liver disease (Spontaneous Bacterial Peritonitis - SBP); Females; Immune compromised; Post Splenectomised; Peritoneal dialysis patient; Ascites

Difference between exudate and transudate in ascites?

Exudate active ( caused by obstruction of lymphatics/venous drainage: eg Congestive cardiac failure, Constrictive pericarditis, Nephrotic syndrome ) and transudate passive and hypoproteineamic state (caused by: cirrhosis/malnutrition/TB)

What is peritonitis?

Inflam of the pertonieum

How is peritonitis classified?

Onset: acute or chronic: Origin: Prim or Sec; Cause: Bacterial or Chem; Location: generalised or localised

Cause of Secondary Peritonitis?

Perforation of hollow viscus; Contamination of cavity with secretions, organism eg peptic ulcer, colonic diverticulum, appendix, bladder; Inflammation of abdominal organs- Appendix, pancreas, small bowel, colon , gall bladder; Peritoneal dialysis patient; TB; Ischaemia hollow viscus; Chemical contamination - starch - surgical glove

How would you treat ascites?

Treatment of underlying cause + Adjuncts: 95% due to portal hypertension so give Diuretics Spironolactone, Furosemide, Amilioride, Metalazone, Mannitol; Salt and Fluid restriction; Albumen / colloid replacement; Paracentesis; Shunts; Portosystemic shunts (liver cirrhosis); Peritoneovenous shunt

What is Refractory ascites?

ascites which cannot be mobilized by low sodium diet and maximal doses of diuretics, occurs in 5% of cirrhotic patients with ascites