Diagnosis and treatment protocols for Peritonitis in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Severe and continuous pain (generalised if whole peritoneum affected). Abdominal swelling, fever, vomiting, tachycardia, hypoxia. Hypovolemic shock. Tender rigid abdomen, rebound tenderness. Absent bowel sounds.
Investigations
Abdominal X-ray/ultrasound. CBC, culture and sensitivity. Renal and Liver function tests.
Emergency Management
Initial Treatment before referral
Put up IV drip (Normal saline/Ringer’s lactate: 1 L every 1-2 hrs until BP normal, then 1 L every 4-6 hrs). Nil by mouth. Pass NGT and start suction. Oxygen if hypoxic.
Pain Control
Pethidine 50 mg IM/IV (Child: 0.5-2 mg/kg) OR Morphine 5-15 mg IV/IM/SC. AVOID NSAIDs.
Suspected Bacterial Infection
Minimum 7-day course: Ceftriaxone 1-2 g IV once daily (Child: 50 mg/kg) PLUS gentamicin 7 mg/kg IV daily (Child: 2.5 mg/kg 8-hourly) PLUS metronidazole 500 mg IV infusion 8-hourly.
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