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1. How can bacteria enter the peritoneal cavity?
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Correct answer:
(1) From the exterior.
(2) From intra-abdominal viscera.
(3) Via the bloodstream.
(4) Via the female genital tract.
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2. How can bacteria enter the peritoneal cavity from the exterior?
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Correct answer:
(1) Penetrating wound.
(2) Infection at laparotomy.
(3) Peritoneal dialysis.
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3. How can bacteria enter the peritoneal cavity from intra-abdominal viscera?
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Correct answer:
(1) Gangrene of a viscus, e.g. acute appendicitis, acute cholecystitis, diverticulitis or infarction of the intestine.
(2) Perforation of a viscus, e.g. perforated duodenal ulcer, perforated appendicitis, rupture of intestine from trauma.
(3) Postoperative leakage of an intestinal suture line.
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4. How can bacteria enter the peritoneal cavity via the bloodstream? Which organisms are usually involved?
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Correct answer:
As part of septicaemia (pneumococcal, streptococcal or staphylococcal). This has wrongly been termed primary peritonitis; in fact, it is secondary to some initial source of infection.
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5. How can bacteria enter the peritoneal cavity via the female genital tract?
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Correct answer:
Acute salpingitis or puerperal infection.
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6. What is the pathology of peritonitis?
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Correct answer:
Peritonitis of bowel origin usually shows a mixed faecal flora (Escherichia coli, Streptococcus faecalis, Pseudomonas, Klebsiella and Proteus, together with anaerobic Clostridium and Bacteroides). Gynaecological infections may be chlamydial, gonococcal or streptococcal. Blood-borne peritonitis may be streptococcal, pneumococcal, staphylococcal or tuberculous. In young girls, a rare gynaecological infection is due to pneumococcus. The pathological effects of peritonitis are as follows. (1) Widespread absorption of toxins from the large, inflamed surface. (2) The associated paralytic ileus with: (a) loss of fluid, (b) loss of electrolytes, (c) loss of protein. (3) Gross abdominal distension with elevation of the diaphragm, which produces a liability to lung collapse and pneumonia.
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7. Which bacteria are involved in peritonitis of bowel origin?
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Correct answer:
(1) Bacteroides.
(2) Pseudomonas.
(3) Clostridium.
(4) Streptococcus.
(5) Proteus.
(6) Escherichia coli.
(7) Klebsiella.
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8. Which bacteria are involved in peritonitis of gynaecological origin?
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Correct answer:
(1) Gonococcus.
(2) Chlamydia.
(3) Streptococcus.
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9. Which types of bacteria are involved in peritonitis of blood-borne origin?
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Correct answer:
(1) Tuberculous. (2) Pneumococcal. (3) Streptococcal. (4) Staphylococcal.
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10. What is a rare gynaecological cause of peritonitis in young girls?
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Correct answer:
Pneumococcus.
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11. What are the pathological effects of peritonitis?
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Correct answer:
(1) Widespread absorption of toxins from the large, inflamed surface. (2) The associated paralytic ileus with: (a) loss of fluid, (b) loss of electrolytes, (c) loss of protein. (3) Gross abdominal distension with elevation of the diaphragm, which produces a liability to lung collapse and pneumonia.
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12. What are the pathological features of paralytic ileus?
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Correct answer:
Loss of fluid; loss of electrolytes; loss of protein.
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13. What are the clinical features of peritonitis?
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Correct answer:
Peritonitis is inevitably secondary to some precipitating lesion, which may itself have definite clinical features, e.g. the onset may be an attack of acute appendicitis or a perforated duodenal ulcer with appropriate symptoms and signs. Early peritonitis is characterized by severe pain; the patient wishes to lie still because any movement aggravates the agony. Irritation of the diaphragm may be accompanied by referred pain to the shoulder tip. Vomiting is frequent. The temperature is usually elevated and the pulse rises progressively. Examination at this time shows localized or generalized tenderness, depending on the extent of the peritonitis. The abdominal wall is held rigidly and rebound tenderness is present. The abdomen is silent, or the transmitted sounds of the heart beat and respiration may be detected. Rectal examination may show tenderness in the pouch of Douglas. In advanced peritonitis the abdomen becomes distended and tympanitic, signs of free fluid are present, the patient becomes increasingly toxic with a rapid, feeble pulse, vomiting is faeculent and the skin is moist, cold and cyanosed (the hippocratic facies).
