Peritonitis

Peritonitis

Peritonitis is inflammation of the peritoneum , the

serous membrane lining the abdominal cavity and
covering the viscera.

Causes:

1)

Bacterial infection such as E.coli, Proteus,

Pseudomonas.
External sources such as injury or trauma .
Inflammation that extends from an organ outside
the peritoneal area such as the kidney.

2)
3)

peritonitis
Other common causes of peritonitis are

appendicitis ,perforated ulcer ,diverticulitis

and bowel perforation .
Peritonitis may also be associated with
abdominal surgical procedures and peritoneal
dialysis.

pathophysiology
Peritonitis

is caused by leakage of contents

from abdominal organs into the abdominal
cavity, usually as a result of inflammation,
infection, ischemia, trauma, or tumor
perforation.
Edema of the tissues results, and exudation
of fluid develops in a short time.

pathophysiology
Fluid

in the peritoneal cavity becomes turbid

with increasing amounts of protein, white
blood cells, cellular debris, and blood.
The immediate response of the intestinal tract
is hypermotility, soon followed by paralytic
ileus with an accumulation of air and fluid in
the bowel.

Clinical Manifestations
Symptoms

depend on the location and extent

of the inflammation.
The pain tends to become constant, localized,
and more intense near the site of the
inflammation. Movement usually aggravates it
The affected area of the abdomen becomes
extremely tender and distended, and the
muscles become rigid.

Clinical Manifestations
Rebound

tenderness and paralytic ileus may be

present.
Nausea and vomiting
Peristalsis is diminished.
The temperature and pulse rate increase.
Elevation of the leukocyte count.

Assessment and Diagnostic Findings

The

leukocyte count is elevated

The hemoglobin and hematocrit levels may be
low if blood loss has occurred
Serum electrolyte studies may reveal altered
levels of potassium, sodium, and chloride.
An abdominal x-ray is obtained, and findings
may show air and fluid levels as well as
distended bowel loops.

Assessment and Diagnostic

Findings
A CT

scan of the abdomen may show abscess

formation.
Peritoneal aspiration and culture and
sensitivity studies of the aspirated fluid may
reveal infection and identify the causative
organisms.

Complications
The

inflammation is not localized and the

whole abdominal cavity becomes involved in a
generalized sepsis.
Shock may result from septicemia or
hypovolemia.
The inflammatory process may cause intestinal
obstruction, primarily from the development of
bowel adhesions.

Complications
Postoperative

complications are wound

evisceration and abscess formation.
The sudden occurrence of serosanguineous
wound drainage strongly suggests wound
dehiscence.

Medical Management
Fluid,,

and electrolyte replacement.

Hypovolemia occurs because massive amounts
of fluid and electrolytes move from the
intestinal lumen into the peritoneal cavity and
deplete the fluid in the vascular space.
Analgesics, Antiemetics are prescribed
Intestinal intubation and suction assist in
relieving abdominal distention and in
promoting intestinal function.

Medical Managemen
Oxygen

therapy by nasal cannula or mask can

promote adequate oxygenation, but airway
intubation and ventilatory
Massive antibiotic therapy is usually initiated
early in the treatment of peritonitis.
Surgical objectives include removing the
infected material and correcting the cause.

Nursing Management
Assessment

of pain, vital signs, GI function,

and fluid and electrolyte balance
Administering analgesic medication and
positioning the patient for comfort are helpful
in decreasing pain.
Accurate recording of all intake and output
and central venous pressure assists in
calculating fluid replacement.

Nursing Management
The

nurse administers and monitors closely

intravenous fluids.
The nurse increases fluid and food intake
gradually and reduces parenteral fluids
The nurse must prepare the patient for
emergency surgery.
The nurse must observe and record the
character of the drainage postoperatively.

Nursing Management
The

nurse to prepare the patient and family for

discharge by teaching the patient to care for
the incision and drains if the patient will be
sent home with the drains still in place.