Peritonitis: Causes, Symptoms & Pathophysiology

Peritonitis

• Peritonitis is a disease where the contents irritate the peritoneum
• Complications include sepsis and metabolic alkalosis
• Other complications are abdominal abscess and bowel obstruction
• Further complications are hypovolemic shock and acute respiratory distress syndrome (ARDS)

Peritonitis Pathophysiology and Etiology

• Peritoneal contents irritate the peritoneum, leading to inflammation
• The compliment system is activated, attracting white blood cells to the irritation site
• Fluid shifts to the area, depleting intravascular volume
• Adhesions develop as part of the inflammatory response

Peritonitis Signs and Symptoms

• Symptoms include abdominal pain and distention
• Rebound tenderness may be present over the affected area
• Fever is a common sign of infection
• Altered bowel habits may occur
• Hypotension and tachycardia can indicate systemic involvement
• Bowel sounds may be diminished or absent
• Paralytic ileus (non-mechanical obstruction) may develop.

Types of Peritonitis

• Primary peritonitis is caused by a blood-borne organism
• Secondary peritonitis results from perforation of an organ spilling contents into the peritoneal cavity

Risk factors

• Examples of events causing secondary peritonitis are a ruptured appendix, ulcer perforation and stab wounds

Labs & Diagnostics

• Diagnostic tests include a history and physical examination, complete metabolic panel and a complete blood count
• Other tests are lactic acid levels, abdominal x-ray, or CT scan
• Blood tests may show falsely elevated Hct due to fluid shift

Nursing Interventions

• Abdominal assessments are essential
• Cold towels can help with fever management, blankets should be removed
• Fall risk is a high priority
• The patient will need drain care and may be placed on bed rest
• Pain management includes pain medication and antiemetics
• Orthostatic measurements are important to prevent falls
• Other treatments are NG tube insertion, IV fluids, and paracentesis

Large Intestinal Obstruction

LIO: A disease of having high metabolic alkalosis with high Obstruction, also involves low metabolic acidosis with low obstruction

Pathophysiology & Etiology

• Fluid, gas, and intestinal contents back up proximally to the obstruction
• Results in proximal bowel distention, which reduces fluid absorption and stimulates intestinal secretion
• Distal bowel empties and collapses, decreasing output
• Pressure in bowel lumen leads to capillary permeability
• Extravasation of fluids and electrolytes into the peritoneal cavity
• Decreasing circulating blood volume causes hypotension & hypovolemic shock + TACHYCARDIA
• Intestinal muscle fatigue and peristalsis stops
• Increasing distention inadequate blood flow to bowel
• Bowel becomes edematous and then ischemic
• Prolonged ischemic leads to necrosis and gangrene (Intestinal Strangulation or Infarction)
• Gangrene leads to perforation (PERFORATED BOWEL EMERGENCY = INFECTION, SEPSIS, and death)*

Causes

• Colorectal cancer
• Diverticular disease
• Adhesions, ischemia, volvulus, Crohn's

Signs & Symptoms

• Abdominal pain

• Nausea/Vomiting (projectile dependent on location)

• Distention

• Constipation

• Gradual onset

• Vomiting: rare

• No stool: "obstipation" (complete vs partial)

• Abdominal distention more noticeable

• Persistent crampy lower abdominal pain

• Feeling of impending doom

• High Pitched = above obstruction

• Absent = paralytic ileus, Hypoactive = LBO

Nursing Interventions

• Early recognition of deterioration in condition is key
• H&P
• Strict I/O

Assessments

• Characteristics of abdominal pain
• Vomitus: onset, frequency, color, odor, amount
• Bowel function: flatus, bowel sounds, bowel movements
• Abdomen: scars, masses, distention, tenderness, rigidity, girth, muscle guarding, rebound pain

Labs & Diagnostics

• Imaging: abdominal XR, CT scan, contrast enema, small bowel follow through
• Blood Tests: CBC, CMP +I WBC (Strangulation/ perforation)
• -I Hct (hemoconcentration)
• Electrolytes, BUN, CREATININE
• LBO: sigmoidoscopy/colonoscopy
• ⬆️Hgb/Hct (bleeding)
• METABOLIC ALKALOSIS

Treatment

• NPO

• NG tube with decompression

• Regain intestinal patency

• Fluid, electrolyte, and acid-base abnormalities

• Tx: regain intestinal patency

• EMERGENCY SURGERY: strangulation or perforation

• Resection of obstructed with anastomosis

• Partial or total colostomy/ileostomy

Small Bowel Obstruction

Pathophysiology & Etiology

• The disorder occurs due to surgical adhesions, hernias, cancer, strictures, Crohn's disease and instussception
• Fluid, gas, and intestinal contents back up proximally of the obstruction
• Results in proximal bowel distention, which reduces fluid absorption & Stimulates intestinal secretion
• Distal bowel empties and collapses
• Pressure in bowel lumen leads to capillary permeability, extravasation of fluids and electrolytes into peritoneal cavity
• Decreasing circulating blood volume causes hypotension & hypovolemic shock + TACHYCARDIA
• Eventually intestinal muscle fatigue and peristalsis stops
• Increasing distention inadequate blood flow to bowel
• Bowel becomes edematous and then ischemic
• Prolonged ischemia leads to necrosis and gangrene (intestinal strangulation or infarction)
• Gangrene leads to perforation (PERFORATED BOWEL EMERGENCY = INFECTION, SEPSIS, and death)

Signs & Symptoms

• Abdominal pain with the feeling of impending doom
• N/V (projectile dependent on location)
• Distention
• Constipation
• Frequent, copious vomiting (bile/stool) if proximal = may produce stool @ first
• Colicky, intermittent pain in mid-upper abdomen
• Minimal abdominal distention if proximal, more if distal
• Rapid onset

Labs & Diagnostics

• Imaging: abdominal XR, CT scan, contrast enema, small bowel follow through
• Blood Tests: CBC, CMP +I WBC (Strangulation/ perforation)
• -I Hct (hemoconcentration)
• Electrolytes, BUN, CREATININE
• ⬆️Hgb/Hct (bleeding)
• METABOLIC ALKALOSIS
• LBO: sigmoidoscopy/colonoscopy

Nursing Interventions

• Tx: regain intestinal patency

• Fluid, electrolyte, and acid-base abnormalities

• Strict I/O and H&P

• Emergency Surgery: Strangulation or perforation and resection of obstructed with anastomosis

Complications

• perforation
• MONITOR: I/O, connect to suction
• Bowel Distention + RISK of edema, necrosis, and

SBO Pathophysiology

• Adhesion develops + blocks and peristalsis in ileum
• Gas, fluid, contents that build up proximal to obstruction, then collapses distal to obstruction

SBO Medical Intervention

• Pain medication, NG tube placement and antiemetic

Pancreatitis

• Disease from inflammation of the pancreas
• Can vary from mild to severe hemorrhagic necrosis

Acute Pancreatitis

Acute Inflammation of pancreas (liver produces bile, gall bladder storage unit) Spillage of pancreatic enzymes into surrounding pancreatic tissue causing autodigestion & severe pain Varies from mild edema to severe, hemorrhagic necrosis

Main Causes

• gallstones in women and alcohol in men
• gallstone (reflux of digestive enzymes back into pancreas from obstructive gallstones)
• 2Chronic alcohol use alcohol exact mechanism unknown.
• DRUG REACTIONS

Signs & Symptoms

• Severe abdominal pain radiating to the back
• sudden onset is deep piercing, continuous, Steady, worsons pain, not relieved w/ vomitin.
• starts when recumbentabdominal -Starts when recumbentabdominal
• abdominal guarding

Risk Factors

gallstone if obstructive pancreatitis the urgent ERCP

Assessments

• manage Pain (WoPOiosmorpnenehvaromorohoneaa,l,nalgesies
• Drainage of necrotic fluid collections (abscess/pseudocyst) Image-guided (IR) or Endoscopic & Supportive care
• ag gress ive hydration
• manage metabolic comp I lications
• minimizing pancreatic stimulation: NPO

Complications

• Systemic: involve hypotension, shock pleural - atelectasis -ARDS -thrombi PE Clot torm hypoglycemial

Labs and diagnostics

• serumanylaselevelwithinaboursas returnsnormal -Serum amylase level TrendingIwithin 12 hrs returns to normal 48-72 hrs LSEARIY" assess for pseudocystlabseess
  • Serum lipa se level levelaigher than normal 145680 levels E Radiates Bacy

Nursing interventions

• Nutrition therapy small reauens feeding hign cardi
• NPO monitorUSlongstanding tachycardia
• electrolyte magnesium
• Electrolyte balance
• monitorinfection diabetes pain management
• aggressive IV hydration
• monitor Fluid, Electrolyte, imbalances

Cholelithiasis

• A disease where the gallbladder stores bile, may or may not be mild nor severe ###Pathophysiology & Etiology
• Most common disorder of biliary system, the exact cause of gallstones(lithe stone) is unknown but develop from the precipitation of bile salts, bilirubin, calcium, and or protein out of bile and cholesterol Cholesterol bile Contributing factors : The bile secreted by the liver may be supersaturated w/ cholesterol.

####Main Complications

• Gangrenous gallbladerruptureleads toperitonitisand SubphrenicAbscess Fistulas Pancreatitis BiltaryCirrhosis Transaminitis

Signs & Symptoms

• Severe to none at all with pain with severe stone movement, more severe during movemen
• Steady and excruciating with tachycardia, diaphoresis, and prostration that moves to shoulder scaplua ###Main Labs and Diagnostics ABX (cholecystitis) : Visualizations using labs

Nursing Intervetnions:

• Manage pain, surgical drains with assessm,ent and post operative care Encourage light diet

###CHolecystitis -Disease with gallbladder that is usually accompanied with gallbladder sludge Signs and Symptoms : Very severe to with steady excruciating, tachycardia, pain is more severe ###Main Labs and Diagnostics: Visualizations using labs or ABD US

###Nursing Interventions

• Manage pain, surgical drains with assessmentm deep breathing, position patient