PERITONITS

DEFINITION:

Peritonitis is an inflammation (irritation) of the peritoneum, the thin tissue that lines the inner
wall of the abdomen and covers most of the abdominal organs

ETIOLOGICAL FACTORS

 Medical procedures, such as peritoneal dialysis. Peritoneal dialysis uses tubes

(catheters) to remove waste products from your blood when your kidneys can no longer
adequately do so. An infection may occur during peritoneal dialysis due to unclean
surroundings, poor hygiene or contaminated equipment.
 A ruptured appendix, stomach ulcer or perforated colon. Any of these conditions can
allow bacteria to get into the peritoneum through a hole in your gastrointestinal tract.
 Pancreatitis. Inflammation of your pancreas (pancreatitis) complicated by infection may
lead to peritonitis if the bacteria spread outside the pancreas.
 Diverticulitis. Infection of small, bulging pouches in your digestive tract (diverticulitis)
may cause peritonitis if one of the pouches ruptures, spilling intestinal waste into your
abdomen.
 Trauma. Injury or trauma may cause peritonitis by allowing bacteria or chemicals from
other parts of your body to enter the peritoneum. Eg: accident.

RISK FACTORS

 Previous history of peritonitis

 History of alcoholism
 Liver disease
 Fluid accumulation in the abdomen
 Weakened immune system
 Pelvic inflammatory disease

PATHOPHYSIOLOGY

Due to etiological factor

Inflammation of the peritoneal cavity

Abcess of infection-due to inflammation

Spread of infection throughout the body

Death in severe cases

CLINICAL FEATURES
  The blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the
abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain,
as the peritoneum snaps back into place).
 Diffuse abdominal rigidity ("abdominal guarding") is often present, especially in
generalized peritonitis
 Fever
 Sinus tachycardia
 Development of ileus paralyticus (i.e., intestinal paralysis), which also causes nausea,
vomiting and bloating.
 Tenderness in your abdomen
 Pain in your abdomen that gets more intense with motion or touch
 Abdominal bloating or distention
 Nausea and vomiting
 Diarrhea
 Constipation or the inability to pass gas
 Minimal urine output
 Anorexia, or loss of appetite
 Excessive thirst
 Fatigue

DIAGNOSTIC EVALUATION

 Physical exam.
 Peritoneal fluid analysis.(Using a thin needle, doctor may take a sample of the fluid in
peritoneum (paracentesis)
 Blood tests.(TWBC)
 Imaging tests (Abdominal X-ray)

MEDICAL TREATMENT

 Fluid. The administration of several liters of an isotonic solution is prescribed.

 Analgesics. Analgesics are prescribed for pain.
 Intubation and suction. Intestinal intubation and suction assist in relieving abdominal
distention and in promoting intestinal function.
 Oxygen therapy. Oxygen therapy by nasal cannula or mask generally promotes adequate
oxygenation.
 Antibiotic therapy. Antibiotic therapy is initiated early in the treatment of peritonitis

Surgery(laparotomy) is to correct any gross anatomical damage that may have caused
peritonitis
COMPLICATION

 A bloodstream infection (bacteremia).

 An infection throughout your body (sepsis). Sepsis is a rapidly progressing, life-
threatening condition that can cause shock and organ failure.

NURSING INTERVENTION

NURSING ASSESSMENT:

 Assessment should be ongoing and precise.

 Pain. Pain should be assessed continuously and should be acted upon.
 GI function. GI function should be monitored to assess response to interventions.
 Fluid and electrolyte. Fluid and electrolytes should be balanced.

NURSING DIAGNOSIS

 Acute pain related to peritoneal irritation.

 Deficient fluid volume related to massive shifting of fluids towards the intestinal lumen
and depletion in the vascular space