THEME V: ACUTE PERITONITIS
1. What is the definition of “acute peritonitis”?
- Acute peritonitis is defined as inflammation of the peritoneal cavity, where the peritoneal fluid increases in volume with the passage of a transudate rich in leucocyte polymorphs and fibrin.
2.There are two forms of acute peritonitis according to the source of infection. Which are they?
Acute peritonitis is classified as rare, Diagnosed by exclusion. Confirmed in retrospect by Cultures
- Primary (spontaneous) – where an infection has arisen de novo within the peritoneum.
- Secondary - where the inflammatory process involving the peritoneum is the result of an identifiable primary process
3. When the diagnosis “primary peritonitis” is accepted?
- Only cases in which careful exploration of the peritoneal cavity doesn’t establish the source of infection.
- Every case of acute peritonitis must be considered as a secondary acute suppurative peritonitis, treated by operation.
4. Which are the sources of the infection in cases of acute secondary suppurative peritonitis?
- GI perforation (most common source of infection): perforated ulcer, appendix, diverticulum
- Transmural translocation (no perforation): pancreatitis, ischaemic bowel
- Exogenous contamination: drains, open surgery, penetrating abdominal trauma, female genital tract infection (pelvic inflammatory disease)
5. Which 2 syndromes will develop as a result of massive absorption of inflammatory mediators from the peritoneal cavity in cases of acute secondary suppurative peritonitis?
As a result of massive absorption of inflammatory mediators from the peritoneal cavity
- The Systemic inflammatory response syndrome (SIRS) WBC >12,000
- Multiorgan dysfunction syndrome (MODS) are developed. CNS - Altered Mental States
6. Based on the spreading of inflammatory process into the peritoneal cavity, acute peritonitis, is divided into two types. Which are they?
- Localized acute peritonitis. a) Confined: Intraperitoneal Abscess b) Non-confined: Doesn't pass 2 Peritoneal Neighbouring areas
- Generalized acute peritonitis. a) Diffuse: outside 2 Neighbouring areas but not more than 2 floors b) Total: 3 floors affected
7. The peritoneal cavity is dived into three floors. Which are they?
Upper - Above mesocolon transversum [supracolic]
Middle - Between mesocolon transversum and linea inominata pelvis Illiopectineal line
Lower - Below linea inominata pelvis