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Peritonitis

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WHAT IS IT?

Abstract

 

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.

 

 

CAUSES
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.

 

 

- Tachycardia.

 

 

- Tachypnoea.

 

 

- Low blood pressure.

 

 

- Dehydration.

 

 

- Abdominal distension. Eventually absent bowel sounds.

 

 

- Vomiting.

 

 

- Pyrexia.

 

 

- Weakness.

 

 

COMPLICATIONS
Complications of peritonitis can include:

 

 

- Abscesses;

 

 

- Adhesions;

 

 

- Septicaemia;

 

 

- Paralytic ileus;

 

 

- Organ failure.

 

 

INVESTIGATIONS
- Medical assessment.

 

 

- X-ray.

 

 

- Full blood count.

 

 

- Electrolytes.

 

 

- Urea.

 

 

- Creatinine.

 

 

- Serum amylase.

 

 

TREATMENT
- 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.

 

 

NURSING IMPLICATIONS
- 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.

 

 

RESEARCH STUDIES
BMJ’s Clinical Evidence: http://bmj.com/search.dtl

 

 

PUBMED: www.ncbi.nlm.nih.gov/entrez/query.fcgi

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