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11. Peritonitis & Intra-Abdominal Sepsis

Created by Darian

p.1

What are the two types of mesoderm that differentiate during the development of the peritoneum? A) Visceral and parietal plate mesoderm B) Ectoderm and endoderm C) Basal and submesothelial mesoderm D) Cuboidal and columnar mesoderm E) Serous and mucous mesoderm

Select an answer

p.1

Explanation

No explanation provided.

Click to see question

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p.1
Embryology and Anatomy of the Peritoneum

What are the two types of mesoderm that differentiate during the development of the peritoneum?
A) Visceral and parietal plate mesoderm
B) Ectoderm and endoderm
C) Basal and submesothelial mesoderm
D) Cuboidal and columnar mesoderm
E) Serous and mucous mesoderm

A) Visceral and parietal plate mesoderm
Explanation: During development, the mesoderm differentiates into visceral plate mesoderm and parietal plate mesoderm, which are essential for forming the visceral and parietal peritoneum.

p.12
Diagnostic Studies for Peritonitis

Which imaging technique is more accurate for determining the anatomic location and complexity of an abscess?
A) X-ray
B) U/S (Ultrasound)
C) CT scan
D) MRI
E) Fluoroscopy

C) CT scan
Explanation: CT scans are highlighted as being more accurate in determining the anatomic location, size, and complexity of an abscess, especially when IV contrast is used for characterization.

p.1
Embryology and Anatomy of the Peritoneum

What divides the peritoneal cavity into the greater and lesser sac?
A) The diaphragm
B) The omentum
C) The foramen of Winslow
D) The mesentery
E) The retroperitoneal structures

C) The foramen of Winslow
Explanation: The peritoneal cavity is divided into the greater and lesser sac, which communicate via the foramen of Winslow, an important anatomical feature.

p.11
Clinical Features and Symptoms of Peritonitis

What is a common clinical manifestation of intra-abdominal abscess (IAA)?
A) Chest pain
B) Abdominal pain
C) Headache
D) Joint pain
E) Skin rash

B) Abdominal pain
Explanation: The classic presentation of IAA includes abdominal pain, which is a primary symptom that indicates the presence of an abscess in the abdominal cavity.

p.11
Clinical Features and Symptoms of Peritonitis

Which of the following symptoms may indicate an underlying ileus associated with sepsis?
A) Diarrhea
B) Nausea and vomiting
C) Fever
D) Cough
E) Fatigue

B) Nausea and vomiting
Explanation: Nausea and vomiting can suggest the presence of an ileus, which is often associated with sepsis, indicating a disruption in normal bowel function.

p.6
Clinical Features and Symptoms of Peritonitis

How does visceral peritoneal irritation typically present?
A) Sharp and localized pain
B) Dull and poorly localized pain
C) Severe and constant pain
D) Intermittent cramping pain
E) No pain at all

B) Dull and poorly localized pain
Explanation: Visceral peritoneal irritation often presents as dull and poorly localized pain, which can progress to more severe and localized pain as the condition worsens.

p.2
Pathophysiology of Peritonitis

Which of the following is a potential space for fluid accumulation?
A) Right and left subphrenic spaces
B) Liver
C) Stomach
D) Pancreas
E) Spleen

A) Right and left subphrenic spaces
Explanation: The right and left subphrenic spaces are specifically mentioned as potential sites for fluid accumulation and abscess collection.

p.9
Primary, Secondary, and Tertiary Peritonitis

What characterizes tertiary peritonitis?
A) It is always surgically treatable
B) It occurs without identifiable surgically correctable focus
C) It is caused by a single pathogen
D) It is always associated with high-grade pathogens
E) It resolves spontaneously

B) It occurs without identifiable surgically correctable focus
Explanation: Tertiary peritonitis is characterized by its persistence or recurrence without an identifiable surgically correctable focus, often following unresolved primary or secondary peritonitis.

p.2
Clinical Features and Symptoms of Peritonitis

Which type of pain is associated with the visceral peritoneum?
A) Sharp and localized
B) Dull and poorly localized
C) Intense and acute
D) Throbbing and intermittent
E) Radiating and severe

B) Dull and poorly localized
Explanation: The visceral peritoneum is supplied by nonsomatic nerves, leading to visceral pain that is described as dull and poorly localized.

p.7
Etiology of Peritonitis

Which organism is commonly associated with spontaneous peritonitis in children with nephrotic syndrome?
A) Escherichia coli
B) Streptococcus pneumoniae
C) Staphylococcus aureus
D) Pseudomonas aeruginosa
E) Mycobacterium tuberculosis

B) Streptococcus pneumoniae
Explanation: In children with nephrotic syndrome, spontaneous peritonitis is often caused by Streptococcus pneumoniae, particularly in adolescent females.

p.5
Pathophysiology of Peritonitis

What is the primary cardiovascular effect of extracellular fluid (ECF) loss in peritonitis?
A) Increased heart rate
B) Increased vascular resistance
C) Decreased cardiac output
D) Increased blood pressure
E) Decreased respiratory rate

C) Decreased cardiac output
Explanation: ECF loss results in decreased venous return (VR), decreased cardiac output (CO), and heart rate (HR), which are critical cardiovascular responses in peritonitis.

p.12
Management and Treatment of Peritonitis

What is a significant advantage of percutaneous drainage?
A) Requires general anesthesia
B) Longer hospital stay
C) Fewer complications
D) Higher morbidity
E) Complex abscess success

C) Fewer complications
Explanation: Percutaneous drainage offers several advantages, including no need for general anesthesia, reduced hospital stay, and fewer complications, making it a preferred method for simple, unilocular abscesses.

p.11
Clinical Features and Symptoms of Peritonitis

What is a significant sign of fever in patients with intra-abdominal abscess?
A) It is always present
B) It is intermittent at first
C) It is absent in all patients
D) It is always low-grade
E) It is only present in elderly patients

B) It is intermittent at first
Explanation: Fever in the context of an abscess typically starts as intermittent and becomes progressively higher as the abscess matures, making it a significant clinical indicator.

p.11
Diagnostic Studies for Peritonitis

What imaging sign may suggest the presence of an abscess on a plain abdominal X-ray (AXR)?
A) Increased bone density
B) Air/fluid levels
C) Enlarged heart shadow
D) Decreased lung volume
E) Normal bowel gas pattern

B) Air/fluid levels
Explanation: On a plain AXR, signs suggestive of an abscess include the presence of air/fluid levels, which can indicate the accumulation of fluid and gas in the abdominal cavity.

p.6
Clinical Features and Symptoms of Peritonitis

What might cause vomiting in a patient with peritonitis?
A) Dehydration
B) Underlying visceral organ pathology
C) Anxiety
D) Medication side effects
E) High fiber diet

B) Underlying visceral organ pathology
Explanation: Vomiting in peritonitis may occur due to underlying visceral organ pathology, such as obstruction, or secondary to peritoneal irritation.

p.7
Classification of Peritonitis

What characterizes primary peritonitis?
A) It is always caused by trauma
B) It develops spontaneously without an anatomical breach
C) It is common in all age groups
D) It is always polymicrobial
E) It is easily treatable with antibiotics

B) It develops spontaneously without an anatomical breach
Explanation: Primary peritonitis occurs spontaneously in the absence of an anatomical breach of the gastrointestinal tract and is rare, accounting for less than 1% of peritonitis cases.

p.4
Pathophysiology of Peritonitis

What role do cytokines play in peritonitis?
A) They inhibit the inflammatory response
B) They promote further local inflammation
C) They are responsible for blood clotting
D) They decrease fluid production
E) They enhance nutrient absorption

B) They promote further local inflammation
Explanation: Cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF) are released by neutrophils during peritonitis and promote further local inflammation, exacerbating the condition.

p.8
Pathophysiology of Peritonitis

What is a common characteristic of secondary peritonitis?
A) It is always viral in origin
B) It occurs due to loss of integrity of the gastrointestinal tract
C) It is localized to one organ only
D) It is primarily caused by fungal infections
E) It is always associated with trauma

B) It occurs due to loss of integrity of the gastrointestinal tract
Explanation: Secondary peritonitis arises when there is a loss of integrity of the gastrointestinal tract, which can result from various causes including trauma, surgery, or primary disease of the abdominal viscera.

p.1
Embryology and Anatomy of the Peritoneum

What is the approximate surface area covered by the peritoneal membrane?
A) 0.5 m²
B) 1.0 m²
C) 1.5 m²
D) 1.7 m²
E) 2.0 m²

D) 1.7 m²
Explanation: The peritoneal membrane spans an approximate surface area of 1.7 m², which includes both the visceral and parietal peritoneum.

p.12
Management and Treatment of Peritonitis

What is a disadvantage of percutaneous drainage?
A) Requires general anesthesia
B) Low success in complex abscesses
C) Shorter drainage time
D) Higher morbidity
E) Increased hospital stay

B) Low success in complex abscesses
Explanation: A noted disadvantage of percutaneous drainage is its low success rate in treating complex abscesses, which may require alternative drainage methods.

p.3
Physiology and Functions of the Peritoneum

What is the predominant protein found in peritoneal fluid?
A) Fibrinogen
B) Albumen
C) Immunoglobulin G
D) Hemoglobin
E) Collagen

B) Albumen
Explanation: The peritoneal fluid contains less than 3 grams per ml of protein, predominantly albumen, indicating its composition and function.

p.9
Management and Treatment of Peritonitis

What is the primary goal of initial management in peritonitis?
A) Pain relief
B) Aggressive resuscitation and stabilization
C) Surgical intervention
D) Antibiotic de-escalation
E) Nutritional support

B) Aggressive resuscitation and stabilization
Explanation: Initial management of peritonitis involves aggressive resuscitation and stabilization due to significant fluid and electrolyte loss, making it crucial for patient recovery.

p.10
Bacteriologic Findings

What type of bacterial flora is typically found in infections following secondary peritonitis?
A) Only Gram-positive bacteria
B) Polymicrobial, reflecting mixed aerobic-anaerobic flora
C) Only anaerobic bacteria
D) Sterile flora
E) Only Gram-negative bacteria

B) Polymicrobial, reflecting mixed aerobic-anaerobic flora
Explanation: Infections following secondary peritonitis are typically polymicrobial, characterized by a mix of aerobic and anaerobic bacteria.

p.6
Clinical Features and Symptoms of Peritonitis

What does the presence of hypoactive to absent bowel sounds indicate in a patient with peritonitis?
A) Normal gastrointestinal function
B) Gastrointestinal obstruction
C) Generalized ileus
D) Increased bowel activity
E) Dehydration

C) Generalized ileus
Explanation: Hypoactive to absent bowel sounds in a patient with peritonitis reflect a generalized ileus, which is a common finding in this condition.

p.7
Etiology of Peritonitis

Which type of peritonitis is associated with long-term indwelling catheters for dialysis?
A) Primary peritonitis
B) Tuberculous peritonitis
C) Aseptic peritonitis
D) Peritonitis in patients with CAPD
E) Granulomatous peritonitis

D) Peritonitis in patients with CAPD
Explanation: Peritonitis in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD) occurs due to long-term indwelling catheters, with common isolates including Staphylococcus epidermidis.

p.5
Pathophysiology of Peritonitis

What respiratory complication is associated with abdominal distention in peritonitis?
A) Increased lung capacity
B) Enhanced diaphragm movement
C) Respiratory restriction and fatigue
D) Improved oxygenation
E) Decreased respiratory rate

C) Respiratory restriction and fatigue
Explanation: Abdominal distention can lead to diaphragm movement restriction, resulting in respiratory fatigue and diminished ventilatory volume, contributing to atelectasis.

p.6
Clinical Features and Symptoms of Peritonitis

What is the most common presenting symptom of peritonitis?
A) Vomiting
B) Anorexia
C) Abdominal pain
D) Fever
E) Diarrhea

C) Abdominal pain
Explanation: Abdominal pain is the common presenting symptom of peritonitis, often aggravated by movement, including respiration, and can vary in character depending on the etiology.

p.7
Diagnostic Studies for Peritonitis

What is the primary method for diagnosing peritonitis?
A) Imaging studies only
B) Clinical diagnosis
C) Blood tests only
D) Urinalysis only
E) Surgical exploration only

B) Clinical diagnosis
Explanation: Peritonitis is primarily diagnosed clinically, and urgent laparotomy should not be delayed for unnecessary investigations, emphasizing the importance of clinical assessment in urgent situations.

p.7
Diagnostic Studies for Peritonitis

Which of the following is NOT a laboratory test used in the diagnosis of peritonitis?
A) FBC
B) CRP
C) Amylase
D) MRI
E) Urinalysis

D) MRI
Explanation: MRI is an imaging study, not a laboratory test. Laboratory tests such as FBC, CRP, and Amylase are used to assess inflammatory markers and biochemical status in peritonitis.

p.4
Pathophysiology of Peritonitis

What initiates the inflammatory response in peritonitis?
A) Increased blood flow to the heart
B) Mesothelial cell injury due to pathological stimuli
C) Decreased oxygen levels in the blood
D) Release of hormones from the pancreas
E) Activation of the digestive enzymes

B) Mesothelial cell injury due to pathological stimuli
Explanation: The inflammatory response in peritonitis is initiated when pathological stimuli, such as bacteria or chemicals, cause injury to mesothelial cells, leading to a uniform inflammatory response.

p.8
Classification of Peritonitis

Which of the following is NOT a common cause of secondary peritonitis?
A) Penetrating trauma
B) Leakage of bile into the peritoneal cavity
C) Appendicitis
D) Viral infection
E) Previous intra-abdominal surgery

D) Viral infection
Explanation: Secondary peritonitis is commonly bacterial and does not typically arise from viral infections. It can result from penetrating trauma, leakage of bile, or complications from previous surgeries.

p.1
Embryology and Anatomy of the Peritoneum

What is the primary function of the visceral peritoneum?
A) To provide structural support to the abdominal wall
B) To secrete serous fluid and invest the diaphragm and abdominal wall
C) To create a closed cavity for the abdominal organs
D) To connect the abdominal organs to the spine
E) To protect the abdominal organs from infection

B) To secrete serous fluid and invest the diaphragm and abdominal wall
Explanation: The visceral peritoneum secretes serous fluid and covers the diaphragm, abdominal wall, and pelvic surfaces, playing a crucial role in reducing friction between organs.

p.8
Pathophysiology of Peritonitis

What type of bacteria is typically involved in secondary peritonitis?
A) Only gram-positive bacteria
B) Only gram-negative bacteria
C) Polymicrobial flora including gram positives, gram negatives, and anaerobes
D) Fungal organisms
E) Mycobacterial species

C) Polymicrobial flora including gram positives, gram negatives, and anaerobes
Explanation: Secondary peritonitis is commonly bacterial, with the flora typically being polymicrobial, which includes a mix of gram-positive, gram-negative, and anaerobic bacteria.

p.3
Physiology and Functions of the Peritoneum

Which cells are primarily found in peritoneal fluid?
A) Erythrocytes
B) Neutrophils
C) Lymphocytes
D) Platelets
E) Basophils

C) Lymphocytes
Explanation: Peritoneal fluid contains less than 3000 cells per ml, with 50% being lymphocytes, indicating the immune response within the peritoneal cavity.

p.9
Management and Treatment of Peritonitis

What type of fluids are preferred for initial management of peritonitis?
A) Colloids
B) Crystalloids
C) Hypertonic saline
D) Dextrose solutions
E) Blood products

B) Crystalloids
Explanation: Crystalloids are the fluids of choice in the initial management of peritonitis, as they are titrated according to hemodynamic demand to effectively rehydrate patients.

p.7
Diagnostic Studies for Peritonitis

What is the main goal of diagnostic studies in peritonitis?
A) To delay treatment
B) To confirm diagnosis and find the cause
C) To perform unnecessary imaging
D) To avoid laboratory tests
E) To provide comfort measures only

B) To confirm diagnosis and find the cause
Explanation: The goals of diagnostic studies in peritonitis include guiding resuscitation and stabilization, confirming the diagnosis, and identifying the underlying cause.

p.4
Clinical Features and Symptoms of Peritonitis

Which cells predominantly respond in the initial phase of peritonitis?
A) Erythrocytes
B) Neutrophils
C) Macrophages
D) Lymphocytes
E) Platelets

C) Macrophages
Explanation: In the initial phase of peritonitis, macrophages are the predominant inflammatory cells, followed by neutrophils within 2-4 hours, which play a crucial role in the inflammatory response.

p.5
Pathophysiology of Peritonitis

What is the effect of aldosterone secretion in the context of peritonitis?
A) Sodium loss and potassium retention
B) Potassium loss and sodium retention
C) Water loss and sodium retention
D) Potassium retention and water loss
E) Sodium loss and water retention

B) Potassium loss and sodium retention
Explanation: Aldosterone secretion leads to potassium loss and sodium retention, which contributes to water retention, impacting fluid balance during peritonitis.

p.8
Clinical Features and Symptoms of Peritonitis

What is the hallmark symptom of secondary peritonitis?
A) Fever
B) Abdominal pain
C) Diarrhea
D) Jaundice
E) Chest pain

B) Abdominal pain
Explanation: Abdominal pain is the hallmark symptom of secondary peritonitis, and its specific characteristics can help direct the diagnosis and identify the underlying cause.

p.10
Diagnosis

What is a key characteristic that differentiates tertiary peritonitis (TP) from secondary peritonitis?
A) Presence of a perforation
B) No obvious anatomical defect found on reoperation
C) Always requires surgical intervention
D) High levels of white blood cells
E) Clear predictive parameters available

B) No obvious anatomical defect found on reoperation
Explanation: In patients with tertiary peritonitis, there is usually no obvious anatomical defect or perforation of the hollow viscus found during reoperation, which helps differentiate it from secondary peritonitis.

p.10
Classification of Peritonitis

Which of the following is NOT a form of peritonitis mentioned?
A) Granulomatous peritonitis
B) Drug-related peritonitis
C) Viral peritonitis
D) Talcum peritonitis
E) Hyperlipidaemic peritonitis

C) Viral peritonitis
Explanation: The text lists various forms of peritonitis, but viral peritonitis is not mentioned, making it the correct answer.

p.4
Embryology and Anatomy of the Peritoneum

What are microvilli and their function in the peritoneum?
A) They are large cells that absorb nutrients
B) They are present at the apical surface and release surfactant for a friction-free state
C) They are responsible for blood circulation
D) They are involved in the production of hormones
E) They are the primary immune cells in the peritoneum

B) They are present at the apical surface and release surfactant for a friction-free state
Explanation: Microvilli are present at the apical surface of the peritoneum and are involved in releasing surfactant, which allows for a friction-free state, facilitating movement and function within the abdominal cavity.

p.12
Diagnostic Studies for Peritonitis

What imaging technique is helpful in determining the size and shape of an intra-abdominal mass?
A) X-ray
B) MRI
C) U/S (Ultrasound)
D) CT scan
E) PET scan

C) U/S (Ultrasound)
Explanation: Ultrasound is noted for its usefulness in determining the size, shape, consistency, and anatomic relationships of an intra-abdominal mass, although it may yield poor results if there are gas-filled viscera or postoperative complications.

p.3
Physiology and Functions of the Peritoneum

What is the typical volume of peritoneal fluid?
A) Less than 10 ml
B) Less than 50 ml
C) Less than 100 ml
D) Less than 200 ml
E) Less than 300 ml

B) Less than 50 ml
Explanation: The peritoneal fluid is typically less than 50 ml and is clear, consisting of water, electrolytes, and solutes derived from interstitial fluid and plasma.

p.12
Management and Treatment of Peritonitis

Which drainage method involves entering the peritoneal cavity?
A) Open drainage
B) Laparoscopic drainage
C) Endoscopic drainage
D) Percutaneous drainage
E) All of the above

E) All of the above
Explanation: All listed methods can involve entering the peritoneal cavity, but open drainage specifically refers to draining the abscess through intraperitoneal routes, while laparoscopic and endoscopic methods may also access the cavity.

p.10
Intra-abdominal Abscesses: Etiology and Risk Facto...

Where do intra-abdominal abscesses commonly localize?
A) Only in the liver
B) In the right and left subphrenic spaces, Morrison's pouch, intermesenteric area, and pelvis
C) Exclusively in the pelvis
D) In the thoracic cavity
E) In the lungs

B) In the right and left subphrenic spaces, Morrison's pouch, intermesenteric area, and pelvis
Explanation: The four major intraperitoneal anatomic spaces where abscesses commonly localize include the right and left subphrenic spaces, Morrison's pouch, intermesenteric area, and the pelvis.

p.6
Clinical Features and Symptoms of Peritonitis

What is a common temperature finding in patients with peritonitis?
A) Always normal
B) Elevated (39 - 40 °C)
C) Always subnormal
D) Fluctuating
E) Below 35 °C

B) Elevated (39 - 40 °C)
Explanation: Patients with peritonitis may present with an elevated temperature, typically ranging from 39 to 40 °C, indicating an inflammatory or infectious process.

p.4
Pathophysiology of Peritonitis

What physiological alteration occurs due to fluid shifts in peritonitis?
A) Increased blood volume
B) Fluid shift from intravascular space into the peritoneal cavity
C) Decreased heart rate
D) Enhanced kidney filtration
E) Increased oxygen delivery to tissues

B) Fluid shift from intravascular space into the peritoneal cavity
Explanation: In peritonitis, the inflammatory response causes a fluid shift from the intravascular space into the peritoneal cavity, leading to tissue edema and potential third-space fluid loss.

p.1
Embryology and Anatomy of the Peritoneum

What embryonic layers contribute to the formation of the peritoneum?
A) Ectoderm, mesoderm, and endoderm
B) Ectoderm, endoderm, and endoderm
C) Mesoderm, ectoderm, and ectoderm
D) Endoderm, mesoderm, and ectoderm
E) Endoderm, ectoderm, and mesoderm

E) Endoderm, ectoderm, and mesoderm
Explanation: The peritoneum forms when cells from the three embryonic layers—ectoderm, mesoderm, and endoderm—move into the interior of the embryo during gastrulation, leading to its development.

p.10
Intra-abdominal Abscesses: Etiology and Risk Facto...

What is a common clinical risk factor for developing intra-abdominal abscesses?
A) Young age
B) Chronic glucocorticoid use
C) High physical activity
D) Low body mass index
E) Recent vaccination

B) Chronic glucocorticoid use
Explanation: Chronic glucocorticoid use is identified as a clinical risk factor for developing intra-abdominal abscesses, along with other factors like increasing age and malnutrition.

p.3
Physiology and Functions of the Peritoneum

What role do macrophages play in the peritoneal immune response?
A) They produce antibodies
B) They trap bacteria
C) They perform metabolic bursts to kill pathogens
D) They transport nutrients
E) They form adhesions

C) They perform metabolic bursts to kill pathogens
Explanation: Macrophages in the peritoneal cavity utilize glutamate metabolic bursts as part of their killing mechanisms against pathogens, demonstrating their critical role in the immune response.

p.2
Physiology and Functions of the Peritoneum

What supplies blood to the visceral peritoneum?
A) Intercostal vessels
B) Splanchnic blood vessels
C) Lumbar vessels
D) Iliac vessels
E) Portal vein

B) Splanchnic blood vessels
Explanation: The visceral peritoneum receives its blood supply from the splanchnic blood vessels, while the parietal peritoneum is supplied by intercostal, subcostal, lumbar, and iliac vessels.

p.7
Etiology of Peritonitis

What is a common risk factor for spontaneous peritonitis in adults?
A) Low blood pressure
B) High-volume ascites due to cirrhosis
C) Recent surgery
D) Diabetes mellitus
E) Smoking

B) High-volume ascites due to cirrhosis
Explanation: Adults with high-volume ascites, particularly those with advanced cirrhosis, are at greater risk for developing spontaneous peritonitis.

p.8
Diagnosis of Peritonitis

What is a key diagnostic indicator for foreign body peritonitis?
A) Increased blood pressure
B) High index of suspicion in patients with ascites and cirrhosis
C) Normal glucose levels
D) Decreased white blood cell count
E) Elevated liver enzymes

B) High index of suspicion in patients with ascites and cirrhosis
Explanation: A high index of suspicion is crucial for diagnosing foreign body peritonitis, particularly in patients presenting with ascites and cirrhosis, and is typically made after excluding secondary peritonitis causes.

p.12
Management and Treatment of Peritonitis

What is the mainstay of treatment for intra-abdominal abscesses?
A) Antibiotics
B) Resuscitation
C) Drainage
D) Surgery
E) Observation

C) Drainage
Explanation: Drainage is identified as the mainstay of treatment for intra-abdominal abscesses, with various methods available depending on the complexity and accessibility of the abscess.

p.3
Physiology and Functions of the Peritoneum

What is the specific gravity of peritoneal fluid?
A) Greater than 1.020
B) Less than 1.016
C) Equal to 1.000
D) Equal to 1.050
E) Greater than 1.030

B) Less than 1.016
Explanation: The specific gravity of peritoneal fluid is less than 1.016, which is an important characteristic for understanding its composition.

p.2
Embryology and Anatomy of the Peritoneum

What are the peritoneal ligaments NOT included in the list?
A) Coronary
B) Gastrohepatic
C) Hepatoduodenal
D) Mesenteric
E) Gastrocolic

D) Mesenteric
Explanation: The mesenteric is not listed among the peritoneal ligaments provided in the text, which includes ligaments such as coronary, gastrohepatic, hepatoduodenal, and gastrocolic.

p.9
Management and Treatment of Peritonitis

What does source control in peritonitis management involve?
A) Only surgical intervention
B) Eliminating the source of infection and correcting anatomical derangements
C) Administering antibiotics
D) Providing nutritional support
E) Monitoring vital signs

B) Eliminating the source of infection and correcting anatomical derangements
Explanation: Source control encompasses all measures taken to eliminate the source of infection, reduce bacterial inoculum, and restore normal physiological function, which may involve surgical or nonsurgical procedures.

p.4
Pathophysiology of Peritonitis

What is a potential consequence of the inflammatory response in peritonitis?
A) Increased nutrient absorption
B) Formation of an abscess
C) Decreased blood flow to the brain
D) Enhanced respiratory function
E) Improved kidney function

B) Formation of an abscess
Explanation: The inflammatory response in peritonitis can lead to the production of fibrinogen and the formation of a mesh of fibrin, which can trap bacteria and potentially result in the formation of an abscess.

p.5
Systemic Defence

What role do macrophages play in the systemic defense against peritonitis?
A) They cause tissue damage
B) They promote fluid retention
C) They facilitate phagocytosis
D) They increase heart rate
E) They decrease vascular permeability

C) They facilitate phagocytosis
Explanation: Macrophages are crucial for phagocytosis, helping to clear pathogens and debris in the peritoneal cavity during peritonitis.

p.5
Pathophysiology of Peritonitis

What physiological response occurs due to mesothelial damage in peritonitis?
A) Decreased vascular permeability
B) Increased bacterial influx into the peritoneal cavity
C) Enhanced fibrin formation
D) Improved absorption of exudate
E) Increased oxygenation of tissues

B) Increased bacterial influx into the peritoneal cavity
Explanation: Mesothelial damage can lead to increased bacterial influx into the free peritoneal cavity, exacerbating the infection and inflammatory response.

p.11
Diagnostic Studies for Peritonitis

Which laboratory investigation is likely to show a left-ward shift in white blood cell count (WBC)?
A) Liver function tests (LFTs)
B) Blood cultures
C) Full blood count (FBC)
D) Arterial blood gas (ABG)
E) Urinalysis

C) Full blood count (FBC)
Explanation: A full blood count (FBC) is used to assess the white blood cell count, and a left-ward shift indicates an increased production of immature white blood cells, often seen in infections like peritonitis.

p.6
Clinical Features and Symptoms of Peritonitis

What physical examination finding is commonly associated with peritonitis?
A) Hyperactive bowel sounds
B) Abdominal rigidity
C) Elevated blood pressure
D) Decreased heart rate
E) Normal abdominal tenderness

B) Abdominal rigidity
Explanation: Patients with peritonitis typically exhibit signs of peritoneal irritation, including abdominal rigidity, tenderness, and guarding during physical examination.

p.9
Primary, Secondary, and Tertiary Peritonitis

Which of the following is a risk factor for tertiary peritonitis?
A) Young age
B) Good nutritional status
C) Presence of multidrug-resistant microorganisms
D) Absence of underlying conditions
E) Low body mass index

C) Presence of multidrug-resistant microorganisms
Explanation: The presence of multidrug-resistant microorganisms is a significant risk factor for tertiary peritonitis, especially in critically ill or immunocompromised patients.

p.10
Management and Treatment of Peritonitis

What is the primary management approach for tertiary peritonitis?
A) Immediate surgical intervention
B) Supportive care similar to secondary peritonitis
C) High-dose antibiotics only
D) Observation without treatment
E) Nutritional supplementation only

B) Supportive care similar to secondary peritonitis
Explanation: The management of tertiary peritonitis involves supportive care, similar to that of secondary peritonitis, with no role for surgery unless complications arise.

p.3
Physiology and Functions of the Peritoneum

What mechanism is responsible for the peritoneal clearance of bacteria?
A) Active transport through mesothelial cells
B) Removal through the bloodstream
C) Clearance through the diaphragm via the thoracic duct
D) Filtration through the liver
E) Absorption by the intestines

C) Clearance through the diaphragm via the thoracic duct
Explanation: The peritoneal clearance of bacteria occurs through the diaphragm via the thoracic duct, highlighting the role of anatomical structures in immune function.

p.9
Management and Treatment of Peritonitis

Why is early antibiotic administration critical in managing peritonitis?
A) It reduces pain
B) It prevents surgery
C) Delay translates to high morbidity and mortality
D) It eliminates the need for fluid resuscitation
E) It is not necessary if surgery is planned

C) Delay translates to high morbidity and mortality
Explanation: Early and adequate antibiotic administration is crucial because any delay can lead to increased morbidity and mortality in patients with peritonitis.

p.4
Definition and Mechanism of Peritonitis

What is the definition of peritonitis?
A) Inflammation of the skin
B) Inflammation of the serosal membrane lining the abdominal cavity
C) Inflammation of the lungs
D) Inflammation of the heart
E) Inflammation of the brain

B) Inflammation of the serosal membrane lining the abdominal cavity
Explanation: Peritonitis is defined as the inflammation of the serosal membrane that lines the abdominal cavity and/or the organs contained within it, which can occur due to various stimuli.

p.2
Blood Supply and Venous Drainage

What is the primary drainage route for blood from the parietal peritoneum?
A) Portal vein
B) Inferior vena cava
C) Superior vena cava
D) Renal veins
E) Aorta

B) Inferior vena cava
Explanation: The parietal peritoneum drains venous blood to the inferior vena cava, while the visceral peritoneum drains via the portal vein.

Study Smarter, Not Harder
Study Smarter, Not Harder