Acute Peritonitis

ACUTE PERITONITIS

Q. 1

All of the following regarding diagnosis of acute peritonitis are correct except:    

March 2008

 A

Raised WBC count in peritoneal aspirate

 B

Moderately raised amylase levels are diagnostic of peritonitis

 C

CT scan may aid in diagnosis

 D

Upright films shows free air under the diaphragm

Q. 1

All of the following regarding diagnosis of acute peritonitis are correct except:    

March 2008

 A

Raised WBC count in peritoneal aspirate

 B

Moderately raised amylase levels are diagnostic of peritonitis

 C

CT scan may aid in diagnosis

 D

Upright films shows free air under the diaphragm

Ans. B

Explanation:

Ans. B: Moderately raised amylase levels are diagnostic of peritonitis

Free air is present in radiographs in most cases of anterior gastric and duodenal perforation but is much less frequent with perforations of the small bowel and colon and is unusual with appendiceal perforation.

Upright films are useful for identifying free air under the diaphragm (most often on the right) as an indication of a perforated viscus.

Presence of dilated gas-filled loops of the bowel can also be seen which is consistent with a paralytic ileus.

Serum amylase estimation may establish the diagnosis of acute pancreatitis, but moderately raised levels may be seen in other abdominal catastrophes and operations.

Diagnostic peritoneal lavage (DPL) may be helpful in patients who do not have conclusive signs on physical examination or who cannot provide an adequate history.

A DPL with more than 500 leukocytes/mL is considered positive and suggests peritonitis.

The fluid in bacterial peritonitis generally demonstrates low pH and glucose as well as elevated protein and LDH levels. The drop in peritoneal fluid pH (and P02) is more pronounced in mixed infections and severe bacterial contamination, with increased numbers of anaerobic bacteria in these circumstances.

USG and CT scan are increasingly used to identify the cause of peritonitis (acute pancreatitis).

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