Sandbox: PE

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Overview

Examination reveals signs of acute abdomen and in advanced cases, shows signs of shock and septicemia.

Physical Examination

Appearance of the patient

  • Patients with peritonitis are usually ill-appearing.
  • Initially they appear alerted, restless and irritable.
  • They may later become apathetic and delirious.
  • They are often noticed lying quietly supine, on the bed with the knees flexed and with frequent limited intercostal respirations because any motion intensifies the abdominal pain.

Vital Signs

Temperature

Blood Pressure

Pulse

  • Tachycardia with weak, thready peripheral pulses represents decreased effective circulating blood volume, indicating a stage of shock later in the disease.
  • May be normal or increased in rate due to infection.
  • It may be low in volume due to dehydration.

Respiration

  • Tachypnea due to infection and increased demand.

Skin

Eyes

Neck

Heart

Lungs

Neurologic

Following may be noticed when spontaneous bacterial peritonitis complicates or due to underlying liver or renal failure.

Abdomen

  • Usually tense and distended due to ascites
  • Marked abdominal tenderness to palpation is present.
  • Shifting dullness on percussion is noted in patients with ascites, but may be painful due to infection.
  • Bowel sounds vary along the course of peritonitis, are initially hypoactive, and may disappear later.
  • Absence of bowel sounds may be the only manifestation of peritonitis in some patients, and a high index of suspicion is necessary
  • The absence of any of these findings does not exclude peritonitis.

Extremities