Midgut Hindgut Anatomical limits Lower oesophagus to D2 D2 to 2/3 across Transverse colon
Transverse colon to upper rectum Site of autonomic pain Epigastric Periumbilical Suprapubic +
History Sudden onset (perforation) Poorly localised moving to one point of abdomen Lying still Speedbumps Rest
my hand on it its better or beg you not to examine + Clinical Examination Localised vs generalised Point-tenderness Systemically
vs rigid abdomen shocked + Investigations Blood X-rays CT tests of chest and abdomen scan of abdomen B-HCG!
ECG + Treatment ABC Treat the underlying cause and treat it early Call a surgeon Source control Post-management support + Not just a belly problem Complication of peritonitis Hypovolaemia Kidney failure Systemic Sepsis
Paralytic ileus Pulmonary atelectasis/pneumonia Portal pyaemia + Abscess formation Patient position Location of collection Standing Pelvis
Supine Left or right paracolic gutter Suprahepatic/ sub-phrenic Supine + Primary peritonitis + Primary Peritonitis
Spontaneous Bacterial Peritonitis Ascites Immunocompromised (lymphoma/peritoneal dialysis) Diagnosis is an ascitic tap/blood cultures
Treatment is broad spectrum antibiotics No operation! + Secondary peritonitis + Case 1 25 y.o. male
1 day history of umbilical pain, poorly localised, going to right iliac fossa Off food Low grade fever Raised WCC (15).
O/E Rebound tenderness and guarding in RIF + Diagnosis + Case 2 23 y.o. F
Sudden onset low abdominal pain Acutely hypotensive Missed last period Referred to general surgery as ?appendicitis + Diagnosis?
+ Case 3 50 y.o. male Smoker, diabetic Sudden onset abdominal pain, 10/10
Not settling with morphine + Diagnosis? + Case 4 75 year old smoker B/g acid reflux, uses ibuprofen for arthritis
Previous MI Sudden onset epigastric pain Board like abdomen + Diagnosis? +
Important considerations Pre-morbid Assessing status risk (P-POSSUM, ASA) Conservative Palliation treatment + In summary Peritonitis
Toxins are absorbed Systemic Treat is bad upset underlying cause and complications + Further learning
Good for basic knowledge Lecture notes in General Surgery (Ellis, Calne, Watson) Bailey and Loves Short Practice of Surgery Good for quick revision Oxford handbook of surgery Surgery at a glance xperience is the best tutor for emergency surgery and peritoniti t the surgical admissions unit and emergency theatre to learn m [email protected] @wannabehawkeye
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