’Septic
’Non-septic
2 classifications of peritonitis
Yes
E.g. pancreatitis and enzyme leakage is non-septic, how-
Is there cross over between peritonitis classifications?
ever may spread to other abdominal areas causing infec-
tion
’Intestinal perforation e.g. foreign body
’Haematogenous
Example septic causes of peritonitis ’External penetration usually obvious
’Iatrogenic e.g. recent surgery
’Urinary ascension
’Pancreatitis
’Hepatitis
’Cholangitis
’Splenitis
’Nephritis
Example non-septic causes of peritonitis
’Neoplasia
’Bile
’Urine
’Blood
’Gastric perforation
What should be performed on any patient with abdominal
POCUS
discomfort?
Tap the fluid!
What should we do if we find free fluid on POCUS?
1/7
, No
Need to use peritonitis diagnostics, cannot tell whether
Can we diagnose septic vs non-septic peritonitis via visual septic based on appearance alone
inspection?
’Glucose measurement
’Lactate measurement
4 diagnostic methods for deciding whether fluid is septic
’Cytology
’Diagnostic peritoneal leavage
’Fluid glucose 1mmol less than that of blood
What glucose findings would indicate that fluid is septic
’This is because bacteria in the fluid utilise the glucose as
and why?
an energy source
What lactate findings would indicate that fluid is septic ’Fluid lactate 2mmol more than that of blood
and why? ’Bacteria producing lactate in anaerobic conditions
Why may we not perform cytology when investigating a Time consuming and if patient is in a critical condition it
patient with peritonitis? takes you away from the patient
When we cannot obtain enough peritonitis fluid...
’22ml/kg saline is warmed
How do we perform a diagnostic peritoneal lavage? ’Instil into the abdomen via large bore catheter
’Allow to 'mix' and obtain new sample
’Perform culture and sensitivity
Lactate and glucose concentrations
Which diagnostic fluid tests are not as useful after per-
We've diluted the abdominal fluid so will not reflect true
forming a diagnostic peritoneal lavage?
values!
When may detecting fluid in peritonitis via radiography be Free fluid may be flocculent e.g. pus, appearing more like
diflcult? a soft tissue density
2/7
’Non-septic
2 classifications of peritonitis
Yes
E.g. pancreatitis and enzyme leakage is non-septic, how-
Is there cross over between peritonitis classifications?
ever may spread to other abdominal areas causing infec-
tion
’Intestinal perforation e.g. foreign body
’Haematogenous
Example septic causes of peritonitis ’External penetration usually obvious
’Iatrogenic e.g. recent surgery
’Urinary ascension
’Pancreatitis
’Hepatitis
’Cholangitis
’Splenitis
’Nephritis
Example non-septic causes of peritonitis
’Neoplasia
’Bile
’Urine
’Blood
’Gastric perforation
What should be performed on any patient with abdominal
POCUS
discomfort?
Tap the fluid!
What should we do if we find free fluid on POCUS?
1/7
, No
Need to use peritonitis diagnostics, cannot tell whether
Can we diagnose septic vs non-septic peritonitis via visual septic based on appearance alone
inspection?
’Glucose measurement
’Lactate measurement
4 diagnostic methods for deciding whether fluid is septic
’Cytology
’Diagnostic peritoneal leavage
’Fluid glucose 1mmol less than that of blood
What glucose findings would indicate that fluid is septic
’This is because bacteria in the fluid utilise the glucose as
and why?
an energy source
What lactate findings would indicate that fluid is septic ’Fluid lactate 2mmol more than that of blood
and why? ’Bacteria producing lactate in anaerobic conditions
Why may we not perform cytology when investigating a Time consuming and if patient is in a critical condition it
patient with peritonitis? takes you away from the patient
When we cannot obtain enough peritonitis fluid...
’22ml/kg saline is warmed
How do we perform a diagnostic peritoneal lavage? ’Instil into the abdomen via large bore catheter
’Allow to 'mix' and obtain new sample
’Perform culture and sensitivity
Lactate and glucose concentrations
Which diagnostic fluid tests are not as useful after per-
We've diluted the abdominal fluid so will not reflect true
forming a diagnostic peritoneal lavage?
values!
When may detecting fluid in peritonitis via radiography be Free fluid may be flocculent e.g. pus, appearing more like
diflcult? a soft tissue density
2/7
