PEROTONITIS

PEROTONITIS
Presentation by:
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BSN 3-

Presented to:
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PEROTONITIS
PEROTONITIS
Introduction (Brief Discussion)
Introduction (Brief Discussion)
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Peritonitis is
the infection &
inflammation of
the peritoneum
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Peritonitis spreads
quickly and is a
medical emergency that
requires immediate
treatment
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Peritonitis was
first recognized
as a disease by
a young French
surgeon Bichat
in 1815.
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
He insisted
that the
pathology in
the case was in
the peritoneum
itself.
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
There are 2 types or
classifications of perotonitis:
Infected peritonitis
(localized or generalized
Primary or
infected peritonitis) secondary
peritonitis
or none infected
peritonitis
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Primary peritonitis:
is caused by the
spread of an infection
from the blood and
lymph nodes to the
peritoneum.
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Secondary peritonitis: is
the more common type of
peritonitis, happens when
the infection comes into
the peritoneum from the
gastrointestinal or
biliary tract
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Systemic or localized
infections:
(such as tuberculosis) may
rarely have a peritoneal
localisation.
WHAT
WHATIS
IS
PEROTONITIS?
PEROTONITIS?
Non-infected peritonitis:
Leakage of sterile body fluids into
the peritoneum, such as blood,
gastric juice (e.g., peptic ulcer,
gastric carcinoma), bile (e.g.,
liver), urine (pelvic trauma),
pancreatic juice
(pancreatitis).
PEROTONITIS
PEROTONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY DIAGRAM
PATHOPHYSIOLOGY DIAGRAM
PATHOPHYSIOLOGY DIAGRAM
PATHOPHYSIOLOGY DIAGRAM
PATHOPHYSIOLOGY DIAGRAM
PATHOPHYSIOLOGY DIAGRAM
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Peritonitis is caused by a
bacterial or fungal
infection that begins in the
peritoneum and spreads to
other parts of the body
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Surgery may be required
in some cases to repair
the peritoneum or treat
the underlying cause
of the infection
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Symptoms:
-abdominal pain that worsens
-feeling sick (nausea)
-vomiting, chills, rapid heartbeat,
-lack of appetite, swelling of the
abdomen
-fever
-not passing any urine or less
than normal.
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
The majority of cases of
peritonitis are caused
by an infection or
injury to another part
of the body
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Such as a split, peptic
ulcer, a ruptured appendix,
Crohn's disease and
diverticulitis are two
examples of digestive
disorders.
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
If the inflammation became
severe, the colon has the
potential to split and leak
bowel contents into the
peritoneum, contaminating
it with bacteria.
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
The bacteria involved in
this disease are the gram-
negative aerobic bacteria
Escherichia coli and
Klebsiella pneumoniae.
PERITONITIS
PERITONITIS
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY

Staphylococcus aureus and

other gram-positive
bacteria are suspected of
causing this inflammation.
PEROTONITIS
PEROTONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS
PERITONITIS
PERITONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS

Diffuse abdominal pain is

felt. The pain tends to
become constant,
localized, and more
intense near the site of
the inflammation.
PERITONITIS
PERITONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS

Movement usually
aggravates pain.
PERITONITIS
PERITONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS

The affected area

becomes extremely tender
and distended, and the
muscles become rigid.
PERITONITIS
PERITONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS

Usually, nausea and

vomiting occur and
peristalsis is
diminished.
PERITONITIS
PERITONITIS
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATIONS

Fever, tachycardia,
and leukocytosis
PEROTONITIS
PEROTONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
It is important to
determine if a patient
have peritonitis as soon
as possible since it can
quickly lead to serious
health problems
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

X-rays
imaging tests that make pictures of
body’s tissues, bones and organs.
It is used to check for holes or
other perforations in the
gastrointestinal tract.
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

X-rays
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

Blood, fluid, & urine tests

To find out what is causing the
infection. It also determines if
there are bacteria in the blood,
fluids, and urine.
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

Blood, fluid, & urine tests

PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

CT scans
To show detailed images of any
part of the body. It helps
detects diseases of the small
bowel, colon and other internal
organs. It helps in determining
the cause of unexplained pain.
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

CT scans
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

MRI
An imaging test done with magnetic
fields and radiofrequency energy. It
provides excellent multiplanar tissue
resolution for hermia characterization.
Peritonitis can be seen in the setting
of bowel perforation, diverticulitis,
appendicitis, or sever cholecystitis.
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

MRI
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

Surgery
To remove what is causing
the infection, to reduce
bacterial inoculum, and to
prevent persistent sepsis
PERITONITIS
PERITONITIS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
The following diagnostic test that
are expected to be ordered are:

Surgery
PEROTONITIS
PEROTONITIS
COMPLICATIONS
COMPLICATIONS
PERITONITIS
PERITONITIS
COMPLICATIONS
COMPLICATIONS

Generalized sepsis,
frequently, affects
the whole abdominal
cavity.
PERITONITIS
PERITONITIS
COMPLICATIONS
COMPLICATIONS

Sepsis is the major

cause of death from
peritonitis.
PERITONITIS
PERITONITIS
COMPLICATIONS
COMPLICATIONS

Shock may result

from septicemia
or hypovolemia
PERITONITIS
PERITONITIS
COMPLICATIONS
COMPLICATIONS

The inflammatory process

may cause intestinal
obstruction, primarily
from the development of
bowel adhesions.
PERITONITIS
PERITONITIS
COMPLICATIONS
COMPLICATIONS
The two most common
postoperative
complications are wound
evisceration (next slide)
and abscess formation.
Any suggestion from the
patient that an area of
the abdomen is tender or
painful must be reported.
PEROTONITIS
PEROTONITIS
MEDICAL
MEDICAL MANAGEMENT
MANAGEMENT
PERITONITIS
PERITONITIS
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

Fluid, colloid (blood,

plasma) , and electrolyte
replacement. Hypovolemia
occurs because of massive
loss of fluid and
electrolytes.
PERITONITIS
PERITONITIS
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

Analgesics for pain;

antiemetics for nausea and
vomiting. Intestinal
intubation and suction to
relieve abdominal
distention.
PERITONITIS
PERITONITIS
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

Fluids in the abdominal

cavity can affect lung
expansion and causes
respiratory distress.
Oxygen therapy is
indicated with or without
airway intubation and
ventilatory assistance.
PERITONITIS
PERITONITIS
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

Massive
antibiotic
therapy.
PERITONITIS
PERITONITIS
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

Removing the infected

material and
correcting the cause.
Surgical treatment is
directed toward
excision, resection
with or without
repair, and drainage
PEROTONITIS
PEROTONITIS
NURSING
NURSING MANAGEMENT
MANAGEMENT
PERITONITIS
PERITONITIS
NURSING MANAGEMENT
NURSING MANAGEMENT

Ongoing assessment of
pain, vital signs, GI
function.
PERITONITIS
PERITONITIS
NURSING MANAGEMENT
NURSING MANAGEMENT

The nurse reports

the nature of the
pain, its location
in the abdomen, and
any shifts in
location.
PERITONITIS
PERITONITIS
NURSING MANAGEMENT
NURSING MANAGEMENT

Administering analgesic
medication and
positioning the patient
for comfort. The patient
is placed on the side
with knees flexed; this
position decreases
tension on the abdominal
organs.
PERITONITIS
PERITONITIS
NURSING MANAGEMENT
NURSING MANAGEMENT

Accurate recording
of all intake and
output and central
venous pressure
assists in
calculating fluid
replacement.
PERITONITIS
PERITONITIS
NURSING MANAGEMENT
NURSING MANAGEMENT

The nurse
administers and
monitors closely
intravenous
fluids.
PEROTONITIS
PEROTONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic
PERITONITIS
PERITONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic

According to a journal written by Bryan

D. (2019) pharmacotherapy is used to
patients with peritonitis and abdominal
sepsis to reduce morbidity and prevent
further complications. Such
antimicrobials used are cefotaxime,
gentamicin, ampicillin, and
sulfamethoxazole.
PERITONITIS
PERITONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic

According to him, empiric

antimicrobial therapy must be
comprehensive and should cover
all possible pathogens in the
context of the clinical setting.
Traditionally, an aminoglycoside
and ampicillin combination was
used to treat spontaneous
bacterial peritonitis (SBP).
PERITONITIS
PERITONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic

More than 90 percent of

SBP cases caused by
gram-negative aerobes or
gram-positive cocci are
covered by this
regimen's excellent
empiric coverage.
PERITONITIS
PERITONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic

Cefotaxime, a third-
generation cephalosporin,
has recently been shown to
be as effective as the
ampicillin/aminoglycoside
combination, without the
increased risk of
nephrotoxicity in cirrhotic
patients.
PERITONITIS
PERITONITIS
Summarized Journal Research related to the assigned topic
Summarized Journal Research related to the assigned topic

Enterococci, which are

the pathogen in up to
5% of cases, are not
covered by cefotaxime.