WHAT IS IT?
VOL: 99, ISSUE: 31, PAGE NO: 26
WHAT IS IT?
- The peritoneum is a serous membrane covering the abdominal organs. It consists of a closed sac containing a small amount of serous fluid.
- Peritonitis is an inflammation of the peritoneum caused by contamination of the abdominal cavity. The inflamed peritoneum incites an increase in serous fluid production. This becomes infected as a result of the bacteria present. Toxins are absorbed from the peritoneum and large amounts of fluid are lost into the peritoneal cavity leading to the complications listed below.
- Untreated, it is usually fatal.
Peritonitis is caused by chemical or bacterial contamination:
- Chemical contamination may result from acid, bile or enzymes (for example from a perforated duodenal ulcer or a perforated gall bladder) or blood (for example in an ectopic pregnancy);
- Bacterial contamination may be caused by the rupture of a digestive tract structure (for example small bowel perforation in Crohn’s disease) or traumatic wounds.
SIGNS AND SYMPTOMS
- Pain typically has a sudden onset, is initially localised and worsens on movement.
- Low blood pressure.
- Abdominal distension. Eventually absent bowel sounds.
Complications of peritonitis can include:
- Paralytic ileus;
- Organ failure.
- Medical assessment.
- Full blood count.
- Serum amylase.
- Specific intervention will depend on the underlying cause.
- Rehydration with intravenous fluids.
- Urinary catheterisation.
- Nasogastric tube insertion.
- Possible central line insertion.
- Peritoneal lavage.
- Possible admission to a high dependency unit for close monitoring.
- IV antibiotics.
- If the patient continues to remain pyrexial, tachycardic and in pain, an abdominal abscess should be suspected as a complication.
- Monitoring of patient’s vital signs.
- Monitoring of patient’s fluid balance.
- Analgesia and antiemetics.
- Preparation/education of patient ahead of abdominal surgery.
- Alleviation of patient’s anxiety.
BMJ’s Clinical Evidence: http://bmj.com/search.dtl