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PERITONITIS

By;Mr.Mihir.M.Patel,Nursing Tutor,
Government College of Nursing,Siddhpur.
Definition
It is an inflammation of the peritoneum, the serous
membrane lining the abdominal cavity and covering
the viscera.
Etiology/Risk Factors
1.Primary Causes
Bacterial Infection from organisms infecting the GIT.
Cirrhosis and Ascitis: It provide excellence media for
bacterial growth.
2.Secondary Causes
Appendicitis with rupture
Blunt or penetrating injuries to abdominal organ
Diverticulitis with rupture
Ischemic bowel disorders
Obstruction in GIT
Pancreatitis
Perforated Peptic Ulcer
Patient on continuous ambulatory peritoneal dialysis
Pathophysiology
Etiology factors like appendicitis, rupture,diverticulitis,trauma.

Bacterial invasion from external source Peritoneum exposed to intestinal


content

Septicemia Bacterial proliferation and peritonitis Hyper motility and later


ileus
Increased permeability of peritoneum

Fluid shift to peritoneum

Decreased circulatory fluid volume

Hypovolemia, Shock
Clinical Manifestation
Pain
Rebound Tenderness
Abdomen becomes extremely distended and tender
Paralytic ileus may present
Muscle guarding with rigidity
Nausea and Vomiting
Diminished Peristalsis
Systemic Symptoms Includes;
Fever (100-101F)
Signs of Shock: Tachycardia,Oliguria
Restlessness,weakness,pallor,diaphoresis.
Prolonged peritonitis may cause ARDS.
Diagnostic Evaluation
History Collection

Physical Examination

Blood Investigation

Peritoneal Fluid aspiration

X-ray of abdomen

USG and Ascitis

Peritoneoscopy
Management
Emergency Management
Monitor vital signs,ECG,CVP, Intake and Output
Ratio.
Administer O2 as ordered.
Fluid resuscitation
NG tube insertion to relieve abdominal distention
Initiate TPN within 24-48 hrs.
Bed rest in semi fowlers position to support
ventilation.
Broad spectrum antibiotics
Cont.
Medical Management
Antimicrobial Therapy: Broad spectrum antibiotics,3rd
and 4th generation cephalosporin, amino glycoside.

Pain Management: Opioid Analgesics.

Fluid and Electrolyte Mgt: Crystalloid and Colloids

Nutritional therapy: NG tube insertion to prevent


abdominal distention.
Surgical Management
Surgical Laprotomy:
It is indicated in ruptured appendix, perforation,
obstruction etc. During surgery, all intra abdominal
foreign materials and non viable tissue removed.
Abscesses are drained, drains placed
laparoscopically.
Nursing Management
Resolution of Inflammation
Relief of abdominal pain
Freedom from complication
Adequate nutritional status
Hemodynamic Monitoring
GI function is Assessed
Insert Ryles tube
Maintain fluid and electrolyte balance
Administer anti emetic as ordered
Ensure proper functioning of GI drainage tubes
Thank You