Peritonitis

Surgical treatment for peritonitits

*focus to control/remove the contamination* -exploratory laparotomy (remove/repair inflamed/perforated organ) -colon resection with/without colostomy -draining of peritoneal fluid following surgery

Non-surgical treatment for peritonitis

-NPO -NG tube to suction (decompress stomach) -IV fluids -antibiotics -analgesics -symptomatic treatment (oxygen, electrolytes)

Clinical manifestations for peritonitis

-abdominal pain -Blumberg's sign/rebound tenderness -fever -tachycardia -tachypnea -rigid abdomen -decreased peristalsis -abdominal distention -inability to pass gas/stool -anorexia -N/V -possible compromise in respiratory status (hurts to move/breathe)

Nursing problems and interventions for peritonitis

-acute pain -fluid volume deficit -potential complications -anxiety -knowledge deficit

Causes of primary peritonitis

-blood borne organisms -genital tract organisms -cirrhosis with ascites

What are complications of peritonitis?

-dehydration -oliguria/renal failure -hypovolemic shock -sepsis -intra-abdominal abcess formation -paralytic ileus -bowel obstruction -ARDS (acute respiratory distress syndrome)

Nursing assessment of peritonitis

-pain (location) -vitals -LOC -respiratory status -bowels -abdominal distention -abdominal guarding -nausea -fever -s/s of dehydration/hypovolemic shock

Causes of secondary peritonitis

-peritoneal dialysis -perforation -ruptured appendicitis -trauma to abdominal organs -ruptured diverticulitis -ischemic bowel disorder -pancreatitis -post operative complication

Goals and interventions for peritonitis

-resolution of inflammation -relief of abdominal pain -freedom from complications -normal nutritional status -learning needs evaluation

How is peritonitis diagnosed?

-x-ray (assess for free air/fluid/perforation -ultrasound -CT scan -peritoneal aspiration -blood culture -oxygen saturation, acid-base balance -labs (inc WBC, CBC, CMP, BUN, creatinine)

Peritonitis

acute/chronic inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity; potentially life threatening

What does peritoneal fluid contain?

anti-inflammatory properties, antibodies, immunoglobulins, and white blood cells

Secondary peritonitis

more common; caused by issue in another body region

Primary peritonitis

occurs when disease causing organisms gain entry into the peritoneal cavity causing irritation and chemical peritonitis; bacteria then gain entry and bacterial peritonitis develops in a few hours

What is paralytic ileus?

peristalsis slows or stops in response to the peritoneal inflammation and distention of the intestinal lumen with fluid occurs; also called adynamic bowel

Peritoneal cavity

potential space between the parietal peritoneum and visceral peritoneum; two membranes that separate the organs in the abdominal cavity

Peritoneal fluid

present in between the visceral and parietal membrane; about 50mL of sterile peritoneal fluid; acts as lubrication

Intraperitoneal organs

stomach first 5 cm and 4th part of the duodenum jejunum ileum cecum appendix transverse colon sigmoid colon upper 3rd of the rectum liver spleen tail of the pancreas

Peritoneal cavity Image

two membranes that separate the organs in the abdominal cavity

What happens if inflammatory response fails in primary peritonitis?

widespread inflammation and massive fluid shifts and edema, also causes adhesion as the body attempts to wall off the infection