PERITONITIS

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PERITONITIS
Definition: This is the acute or chronic Inflammation of the peritoneum, the membrane lining the abdominal cavity and covering visceral organs.

TYPES

  •   Primary
  •   Secondary


CAUSES

  • Results from bacteria especially E-Coli, streptococcus, pneumococcal or gonococci
  • Chemical Irritation
  • Bile Spillage
  • Surgical contamination with instruments
  • Penetrating abdominal wound.
  • Gastric or duodenal ulcers
  • Appendicitis


CLINICAL MANIFESTATION

  • Pain: local, diffuse and becoming more intense later.
  • Swelling and tenderness of the abdomen
  • Fever and chills and thirsty
  • Loss of appetite
  • Nausea and Vomiting
  • Decreased bowel sound
  • Abdominal distention
  • Signs of dehydration
  • Hypotension
  • Shallow respiration


PATHOPHYSIOLOGY

  • In a normal condition the peritoneum appears greyish and glistering, but becomes dull after the onset of peritonitis.
  • Peritonitis is caused by leakage of Contents from abdominal cavity, usually as a result of inflammation, infection, Ischemia, trauma or perforation. 
  • Bacteria proliferation occurs and oedema of the tissues results and exudation of the fluid develops.
  • Fluids in the peritoneum becomes turbid with Elevated level of WBC, protein and blood.
  • Immediate response of the GIT is hyper mobility, followed by paralytic illeus with an accumulation of air and fluid in the bowel.
  • The exudate becomes creamy and supportive and may spriead to the whole peritoneum leading to severe abdominal pain, rigid abdomen, swelling, tenderness and fever.



 DIAGNOSTIC EVALUATIONS
  • WBC count will reveal leucocytosis
  • Arterial blood gazes will reveal metabolic acidosis
  • Paracentesis identifies the causative organism
  • Abdominal X-rays may reveal free air in the peritoneal cavity, gas and fluid collection in small and large intestine.
  • Chest X-ray will show Elevated diaphragm


 MANAGEMENT

  • A broad spectrum antibiotics to cover aerobic and anaerobic organisms are the initial treatment followed by specific antibiotics after culture and sensitivity.
  • Analgesics to relieve pain
  • NPO
  • IV fluids and electrolytes
  • Rectal tube to facilitate passage of gas
  • Abdominal Paracentesis may be done to remove accumulating fluid
  • Operative procedures to close perforations, remove infection source, drain abscesses and lavage peritoneal cavity.


NURSING DIAGNOSIS

  • Acute pain related to peritoneal inflammation evidenced by patient's verbalization.
  • Deficit fluid volume related to vomiting and interstitial fluid shift evidenced by dehydration
  • Imbalance nutrition less than body requirement related to GIT hyper motility and infection
  • Ineffective tissue perfusion related to obstruction in circulation.


NURSING MANAGEMENT

  • Monitor vital signs
  • Monitor and document the severity, consistency, location and other characteristics pain.
  • Patient is placed on the side with the knees flexed. This position decreases tension on the abdominal organs and maximise comfort
  • Accurate recording of intake and output
  • Maintain IV therapy
  • Minimize Nausea, vomiting and distention by use of NG suction and antiemetic
  • Monitor for signs of dehydration such as dry mucous membrane
  • Gradually reduce parenteral fluids and give oral fluids and food when peristaltic sound resumes, flatus is passed and patient has bowel movements.
  • Carry out all abdominal surgery pre op and post op care
  • Maintain Drainage if present
  • Teach patient and family how to care for open wounds and drain sites if appropriate and encourage follow up with appointments.


COMPLICATION

  • Septicaemia
  • Hypovolemia
  • Adult respiratory distress
  • Renal or liver failure
  • Supra-abdominal abscess formation
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