Peritonitis and Abdominal Sepsis Questions & Answers

Updated: Jan 11, 2017
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Questions & Answers

Overview

What is peritonitis?

What are causes of peritonitis?

How are peritoneal infections classified?

How is peritonitis diagnosed?

What are the treatment approaches to peritonitis?

What is the anatomy of the peritoneum relevant to peritonitis and abdominal sepsis?

What is the role of peritoneal fluid in peritonitis and abdominal sepsis?

What is the anatomy of the peritoneal cavity relative to peritonitis and abdominal sepsis?

Which bacterial virulence factors are involved in the pathogenesis of peritonitis and abdominal sepsis?

What is the pathophysiology of peritonitis?

What is the pathophysiology of abdominal sepsis?

What is the role of bacterial inoculation of ascites in the pathogenesis of peritonitis and abdominal sepsis?

Which factors contribute to the formation of inflammation and bacterial growth in the pathogenesis of peritonitis and abdominal sepsis?

What is the role of fibrinolysis in the pathogenesis of peritonitis and abdominal sepsis?

What is the significance of bacterial load in the pathogenesis of peritonitis and abdominal sepsis?

What is the role of enterococci in the pathogenesis of peritonitis and abdominal sepsis?

What is the role of fungi in the pathogenesis of peritonitis and abdominal sepsis?

How does abscess formation occur in peritonitis and abdominal sepsis?

What is the role of cytokines in the pathogenesis of peritonitis and abdominal sepsis?

What causes peritonitis and abdominal sepsis?

What is spontaneous bacterial peritonitis (SBP)?

How does spontaneous bacterial peritonitis (SBP) occur?

What are the most common pathogens causing spontaneous bacterial peritonitis (SBP)?

What are the common etiologies of secondary peritonitis (SP)?

Which pathogens are involved in the etiology of secondary peritonitis (SP)?

How is secondary peritonitis (SP) differentiated from SBP in patients with cirrhosis?

Which pathogens are common causes of secondary peritonitis (SP)?

What are rare, nonsurgical causes of intra-abdominal sepsis?

What is the most common cause of postoperative peritonitis?

Which factors increase the risk of peritonitis and abdominal sepsis following surgery for penetrating abdominal trauma?

How frequently does peritonitis complicate peritoneal dialysis?

What are the risk factors for tertiary peritonitis?

What is tuberculosis peritonitis (TP)?

How is tuberculosis peritonitis (TP) diagnosed?

What causes chemical (sterile) peritonitis?

What is the role of peritoneal abscess in the etiology of tertiary peritonitis?

What is the overall incidence of peritoneal infection?

What is the prevalence of spontaneous bacterial peritonitis (SBP)?

Which factors have reduced morbidity and mortality of intra-abdominal sepsis?

What is the mortality rate in spontaneous bacterial peritonitis (SBP)?

What is the mortality rate in uncomplicated secondary peritonitis (SP)?

What is the mortality rate in severe intra-abdominal sepsis and peritonitis?

How do the mortality rates of peritonitis vary among treatments?

What is the prognosis of tertiary peritonitis?

Which prognostic scoring systems are used for peritonitis and abdominal sepsis?

What is the mortality rate for peritonitis and abdominal sepsis without organ failure?

What is the prognosis of peritonitis and abdominal sepsis in patients requiring emergent reoperations?

Which medical conditions are related to worse outcomes and recurrent complications of peritonitis and abdominal sepsis?

What is the risk of developing peritonitis and abdominal sepsis in patients who are older than 65 years?

What are the most significance factors in the prognosis of peritonitis and abdominal sepsis?

Where can patient education resources for peritonitis and abdominal sepsis be found?

Presentation

How is peritonitis diagnosed?

What are the signs and symptoms of spontaneous bacterial peritonitis (SBP)?

How is pain characterized in peritonitis?

What are abdominal symptoms of peritonitis?

Which symptoms of peritonitis may precede the development of abdominal pain?

Which physical findings suggest peritonitis and abdominal sepsis?

How should an abdominal exam be performed for suspected peritonitis?

Which abdominal exam findings are characteristic of peritonitis and abdominal sepsis?

Which rectal exam findings are characteristic of peritonitis and abdominal sepsis?

Which findings are characteristic of peritonitis and abdominal sepsis in females?

How can the differential diagnosis of peritonitis and abdominal sepsis be narrowed on physical exam?

DDX

Which diseases may mimic the signs and symptoms of peritonitis and abdominal sepsis?

Which medical conditions should be considered in the differential diagnoses of peritonitis and abdominal sepsis?

What are the differential diagnoses for Peritonitis and Abdominal Sepsis?

Workup

What is the role of paracentesis in the diagnosis of peritonitis and abdominal sepsis?

Which lab tests are used in the diagnosis and management of spontaneous bacterial peritonitis (SBP)?

What algorithm is useful in the diagnosis and treatment of peritonitis and peritoneal abscess?

What is the role of CBC count in the evaluation of peritonitis and abdominal sepsis?

What is the role of blood chemistry tests in the evaluation of peritonitis and abdominal sepsis?

What is the role of urinalysis in the diagnosis of peritonitis?

What is the role of a stool sample in the diagnosis of peritonitis and abdominal sepsis?

Which finding on ascetic fluid analysis is highly sensitive and specific for spontaneous bacterial peritonitis (SBP)?

What should be included in the evaluation of the peritoneal fluid for the diagnosis of spontaneous bacterial peritonitis (SBP)?

Which findings on peritoneal fluid analysis are characteristic of bacterial peritonitis?

How is the diagnosis of spontaneous bacterial peritonitis (SBP) established?

What is the significance of a finding of culture-negative neutrocytic ascites in the evaluation of peritonitis?

What is the significance of a finding of monomicrobial nonneutrocytic bacterascites in the evaluation of peritonitis?

How is tuberculosis peritonitis (TP) diagnosed?

How is peritonitis diagnosed in patients receiving continuous ambulatory peritoneal dialysis (CAPD)?

When are intraoperative peritoneal fluid cultures indicated?

How is spontaneous bacterial peritonitis (SBP) diagnosed rapidly?

What is the average time saved with bedside reagent strips in the diagnosis of peritonitis and abdominal sepsis?

What is the role of radiography in the diagnosis of peritonitis and abdominal sepsis?

What is the role of abdominal ultrasonography in the diagnosis of peritonitis and abdominal sepsis?

What are the limitations of ultrasonography in the diagnosis of peritonitis and abdominal sepsis?

What are the advantages of ultrasound in the diagnosis of peritonitis and abdominal sepsis?

When is CT scanning indicated for the diagnosis of peritonitis and abdominal sepsis?

How is CT scanning performed in the diagnosis of peritonitis and abdominal sepsis?

What findings on CT scanning are characteristic of secondary peritonitis (SP)?

What is the role of nuclear scanning in the diagnosis of peritonitis and abdominal sepsis?

What is the role of MRI in the diagnosis of peritonitis and abdominal sepsis?

What is the role of contrast studies in the diagnosis of peritonitis and abdominal sepsis?

Treatment

What is focus of treatment in peritonitis and peritoneal abscesses?

How is early control of the septic source of peritonitis achieved?

What is the role of surgery in the treatment of peritonitis and abdominal sepsis?

Which nonoperative interventions are used in the treatment of peritonitis and abdominal sepsis?

What are the general principles guiding the treatment of peritonitis and abdominal sepsis infections?

What is included in medical support for peritonitis and abdominal sepsis?

Which nonoperative therapies are used for early control of the septic source in peritonitis and abdominal sepsis?

What is the initial treatment of peritonitis and abdominal sepsis?

How is hemodynamic resuscitation used in the treatment of peritonitis and abdominal sepsis?

What is the role of antibiotic therapy in the treatment of peritonitis and abdominal sepsis?

What is the optimal duration of antibiotic therapy for peritonitis and abdominal sepsis?

How is abscess drainage performed for the treatment of peritonitis and abdominal sepsis?

When is it advisable to delay surgery for peritonitis and abdominal sepsis?

When is percutaneous drainage of abscesses contraindicated in the treatment of peritonitis and abdominal sepsis?

What is the role of primary percutaneous management in the treatment peritonitis and abdominal sepsis?

What is the role of laparoscopic drainage in the treatment of diverticular peritonitis and abdominal sepsis?

What is the efficacy of laparoscopic lavage in the treatment of peritonitis and abdominal sepsis?

What are the common reasons for failure of primary nonoperative management of peritonitis and abdominal sepsis?

When is primary percutaneous drainage most likely to succeed for the treatment of peritonitis and abdominal sepsis?

Which studies have addressed concerns regarding drainage catheters in deep abscesses the management of peritonitis and abdominal sepsis?

When should percutaneous drainage be considered for primary treatment of peritonitis and abdominal sepsis?

What nutritional support is needed during the treatment of peritonitis and abdominal sepsis?

Which specialist consultations are needed for the treatment of peritonitis and abdominal sepsis?

What are the complications of peritonitis?

What is included in follow-up care for peritonitis and abdominal sepsis?

When is repeat paracentesis indicated in the treatment of spontaneous bacterial peritonitis (SBP)?

What is included in the long-term monitoring of spontaneous bacterial peritonitis (SBP)?

How is follow-up care directed after treatment of peritonitis and abdominal sepsis?

What is included in inpatient care following treatment of peritonitis and abdominal sepsis?

What is included in outpatient care following treatment of peritonitis and abdominal sepsis?

Which groups at high risk of spontaneous bacterial peritonitis (SBP) benefit from outpatient prophylaxis?

What are the suggested regimens for spontaneous bacterial peritonitis (SBP) prophylaxis?

What are adverse effects of long-term SBP prophylaxis?

How is peritonitis prevented?

Medications

What are the goals of drug treatment for peritonitis and abdominal sepsis?

Which medications are used in the treatment of peritonitis and abdominal sepsis?

Which medications in the drug class Glycylcycline Antibiotic are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Anti-Infectives are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Fluoroquinolones are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Carbapenems are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Macrolides are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Penicillins are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Aminoglycosides are used in the treatment of Peritonitis and Abdominal Sepsis?

Which medications in the drug class Cephalosporins are used in the treatment of Peritonitis and Abdominal Sepsis?