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VOL: 99, ISSUE: 31, PAGE NO: 26


- 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.



- Pain typically has a sudden onset, is initially localised and worsens on movement.



- Tachycardia.



- Tachypnoea.



- Low blood pressure.



- Dehydration.



- Abdominal distension. Eventually absent bowel sounds.



- Vomiting.



- Pyrexia.



- Weakness.



Complications of peritonitis can include:



- Abscesses;



- Adhesions;



- Septicaemia;



- Paralytic ileus;



- Organ failure.



- Medical assessment.



- X-ray.



- Full blood count.



- Electrolytes.



- Urea.



- Creatinine.



- Serum amylase.



- Specific intervention will depend on the underlying cause.



- Rehydration with intravenous fluids.



- Urinary catheterisation.



- Nasogastric tube insertion.



- Possible central line insertion.



- Analgesia/antiemetics.



- 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:




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