Acute Peritonitis

Peritonitis: Assessment

-Abdomen. *Abdominal pain. *Abdominal tenderness. *Abdominal distention. *Abdominal guarding. -Localized peritonitis: Tender with palpation, with rebound tenderness. -Generalized peritonitis: Widespread tenderness. -Rigid abdomen. -Nausea. -Vomiting. -Decreased bowel sounds. -No flatus or bowel movements. -High fever. -Tachycardia. -Dehydration. -Decreased urine output. -Hiccups. -Decreased respiration.

What is Peritonitis?

-Acute inflammation and infection of the viscera/parietal peritoneum and endothelial lining of the abdominal cavity. -Can be life threatening.

Peritonitis: Surgical interventions.

-Exploratory laparotomy. -Irrigation of peritoneal cavity. -Surgical drains. -Goal is to repair cause, control contamination, and drain collection of fluid. -What will the nurse monitor post-op? -Discuss open wound with delayed wound closures, surgical drains, level of care. (ICU, Med-surg unit)

Peritonitis: Non-surgical interventions.

-IV fluids. -Broad spectrum antibiotics. (Amoxicillin, Cipro, Levaquin) -Daily weights. -Input and output. -NGT/NPO. -Oxygen, pulse oximetry. -Analgesics.

Why is peritonitis so deadly?

-If left untreated. *Continued leakage of bacteria and chemicals. *Body responds by shunting extra blood to area of infection. *Fluid then shifts into peritoneal cavity and GI tract. *Shifting of fluid from the circulatory volume causes hypovolemic shock. *Shock leads to decreased perfusion of organs. (Kidneys). *Kidney injury results in fluid and electrolyte imbalances. *Peristalsis slows or stops. >Once bowel becomes distended. >Fluid that normally flows through, accumulates. >Up to 7-8 Liters/day. >Bacteria and toxins lean into bloodstream leading to septicemia.

Peritonitis: Diagnostics

-Increased white blood cells. -Blood cultures. -BUN and creatinine. -Hemoglobin and hematocrit. -X-rays. -Ultrasound.

Peritonitis: Patient teaching.

-Length of hospitalization will depend on treatment course. -Discharge teaching should include. *Wound care. *Respiratory care. *Signs and symptoms of infection. *Activity level. *Home healthcare. *Medications: Antibiotics, analgesics.

Pathophysiology of Acute Peritonitis

-Peritoneal cavity contains approximately 50mL of fluid to prevent friction in the abdominal cavity during peristalsis. -Once contaminated, body begins inflammatory process to fight infection. -The inflammatory process increases permeability of cavity, so leukocytes and phagocytes can wall off bacteria. -If wall fails, contamination and inflammation spread, leading to peritonitis. -How does contamination occur? *Perforation (From?). >Appendicitis, diverticulitis, PUD, surgery. *Penetrating wound. *Gengreneous gallbladder. *Bowel obstruction. *Tumors. -Bacterial. *E. Coli. *Strep. *Staph. *Pneumococcus. *Gonococcus. -Chemical. *Leakage of: >Bile. >Pancreatic enzymes. >Gastric acid.

Peritoneum

The serous membrane lining the walls of the abdomen and pelvic cavities (Parietal peritoneum) and investing contained viscera (visceral peritoneum), the two layers enclosing a potential space, the peritoneal cavity.