MCQ - Peritoneum

• Usually confined to the central and paravertebral spaces between the renal arteries and sacrum and tends to encase the aorta, IVC and uretersQ.
• Usually begins at the level of the aortic bifurcation and spreads cephaladQ upto renal artery generally

Around 70% cases are primary or idiopathic

Chronic pancreatitis, Actinomycosis, Tuberculosis, Histoplasmosis - CATHQ

Ureters - Partial or complete obstruction occurs in 75% patientsQ.

• −−Hydronephrosis with dilated tortuous upper ureter,
• −−Medial pulling of ureters or pipestem uretersQ
• −−Extrinsic ureteral compressionQ

• • Primary, idiopathic retroperitoneal fibrosis: Ureteral stenting and immunosuppression (TAPS: Tamoxifen, Azathioprine, Penicillamine, Steroids)Q
• • Secondary retroperitoneal fibrosis: Midline transperitoneal ureterolysis with wrapping the ureter with omental flap or lateral retroperitoneal ureteral transpositionQ

Complication of ascites characterized by spontaneous infection of the ascitic fluid without an intra-abdominal sourceQ.

• In adults: E. coliQ >Klebsiella.
• In children: Group A streptococciQ

• The presence of >250Q polymorphonuclear cells of ascitic fluid is consistent with SBP; with ascitic fluid culture growing single organism.
• If more than two organisms are identified, secondary bacterial peritonitis due to a perforated viscus should be consideredQ.

• • Treated with cefotaxime plus albuminQ
• • Norfloxacin decreases the incidence of SBPQ in patients with variceal bleeding; patients with low-protein ascites and patients with a prior history of SBP.

Occurrence of SBP is an important landmark in natural history of cirrhosis with 1 and 2 year survival rate of 30% and 20%, respectivelyQ

Peptic ulcer perforationQ

E. coli and BacteroidesQ

Staphylococcus epidermidisQ

• Paralytic ileus is the MC complicationQ of typhoid.
• Intestinal hemorrhage (2nd MC)Q may be the leading symptom

• Chylolymphatic (MC)Q
• Simple (mesothelial)
• Enterogenous
• Urogenital remnant
• Dermoid (teratomatous cyst)

• It is the cyst that arises in congenitally misplaced lymphatic tissue that has no efferent communication with the lymphatic system.
• Arises most frequently in the mesentery of the ileumQ.
• Thin wall of the cyst, filled with clear lymph or chyle.

• • Derived either from a diverticulum of the mesenteric border of the intestine or from a duplication of the intestineQ.
• • Thicker wall than a chylolymphatic cyst and it is lined by mucous membrane, sometimes ciliatedQ.
• • Content is mucinous and is either colorless or yellowish brown as a result of past hemorrhage.

Fluctuant swelling near the umbilicus + moves freely in a plane perpendicular to the attachment of the mesentery + zone of resonance around the cystQ.

• • Chylolymphatic cysts: Enucleation is treatment of choiceQ
• • Enterogenous cyst: Resection and anastomosis is the treatment of choice

• Transuduate – Cirrhosis
• Exuduate – Malignancy

• • Pseudomyxoma peritoneiQ
• • Colloid carcinoma of stomachQ or colonQ with peritoneal implants

Ascites and pleural effusion are associated with solid fibroma of the ovaryQ

When amount of fluid exceeds 150 mlQ

• Mucinous ascites arising from a ruptured appendiceal or ovarian adenocarcinomaQ, MC site of primary: AppendixQ
• Peritoneum becomes coated with a mucus-secreting tumor that fills the peritoneal cavity with tenacious semisolid mucus and large, loculated cystic massesQ

Cytoreduction (Resection of as much of the tumor as possible) + Intraperitoneal hyperthermic chemotherapy (IPHC)Q.