Peritonitis: Etiology and Pathophysiology

Peritonitis: Etiology and Pathophysiology

• Peritonitis is inflammation of the peritoneum caused by contamination.
• Contamination sources include bacteria, chemicals, or both.
• Common causes are listed in a table [not included].
• Primary peritonitis: blood-borne organisms enter the peritoneal cavity, unrelated to other abdominal problems. Ascites (fluid buildup) from liver cirrhosis creates a bacterial breeding ground.
• Secondary peritonitis: more common, caused by ruptured or perforated abdominal organs. Ruptured appendix, ulcers, diverticulitis, trauma are common causes.
• Released contents (bile, enzymes, bacteria) irritate the sterile peritoneum initially causing chemical peritonitis.
• Bacterial peritonitis follows, causing fluid shifts (edema) and adhesions.

Clinical Manifestations

• Main symptom: severe, continuous abdominal pain.
• Tenderness over the affected area is a universal sign.
• Rebound tenderness, rigidity, and spasm indicate peritoneal irritation.
• Patients often lie still, breathing shallowly.
• Other symptoms: abdominal distention, fever, tachycardia, tachypnea, nausea, vomiting, altered bowel habits.
• Severity of symptoms varies based on the condition's severity and suddenness.
• Potential complications: hypovolemic shock, sepsis, intra-abdominal abscesses, paralytic ileus, and acute respiratory distress syndrome.
• Peritonitis can be fatal if treatment is delayed.

Diagnostic Studies and Interprofessional Care

• Complete Blood Count (CBC): used to assess white blood cell count (WBC) and hemoconcentration.
• Peritoneal aspiration: fluid analysis for blood, bile, pus, bacteria, fungus, and amylase. Allows for examination and biopsy of the peritoneum.
• Abdominal X-ray: assesses bowel dilation (paralytic ileus), free air (perforation), or air/fluid levels (obstruction).
• Ultrasound and CT scans: identify ascites (fluid buildup) and abscesses.
• Peritoneoscopy may help assess patients without ascites.

Management of Peritonitis

• Conservative Care: milder cases or poor surgical candidates. Includes antibiotics, nasogastric (NG) suction, analgesics, and IV fluids.
• Surgical Care: needed to find the cause, drain fluid, and repair damaged organs (e.g., perforated organs).

Nursing Management: Assessment and Clinical Problems

• Assessment focuses on pain location and quality, bowel sounds, abdominal distention, guarding, nausea, fever, and signs of shock.
• Clinical problems include pain, fluid imbalances, impaired GI function, and infection risk.

Nursing Management: Planning and Implementation

• Goals include treating inflammation, easing pain, avoiding complications (sepsis, shock), and achieving normal nutrition.
• IV access is crucial for fluid replacement, antibiotics, and pain management.
• Pain monitoring and response to analgesics. Positioning for patient comfort.
• Sedatives may be used.
• Close monitoring of fluids, electrolytes, and vital signs are essential.
• Antiemetics are used to reduce nausea and vomiting.
• Patients are placed on nothing-by-mouth (NPO) status.
• NG tubes may be needed for suctioning.
• Oxygen therapy as needed.
• Drains are used postoperatively to remove excess fluid.