Peritonitis: Etiology and Pathophysiology
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Questions and Answers

Which of the following is a potential cause of secondary peritonitis?

  • A viral infection
  • A healthy immune system
  • Excessive exercise
  • A ruptured appendix (correct)

    • What is the most common symptom of peritonitis?

  • Headache
  • Muscle aches
  • Severe, continuous abdominal pain (correct)
  • Loss of appetite

    • What is the initial stage of peritonitis that occurs after abdominal organs release contents into the peritoneal cavity?

  • Sepsis
  • Bacterial peritonitis
  • Paralytic ileus
  • Chemical peritonitis (correct)

    • Which of the following diagnostic studies can be used to identify ascites and abscesses?

    <p>Ultrasound and CT scans (A)</p> Signup and view all the answers

    What is a possible complication of peritonitis?

    <p>Hypovolemic shock (A)</p> Signup and view all the answers

    What is the primary reason for the development of paralytic ileus in patients with peritonitis?

    <p>Inflammation and fluid shifts in the peritoneum (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic sign of peritoneal irritation?

    <p>Decreased abdominal distention (B)</p> Signup and view all the answers

    What is the difference between primary and secondary peritonitis?

    <p>Primary peritonitis is not related to any other intra-abdominal problem, while secondary peritonitis is. (C)</p> Signup and view all the answers

    Which of the following clinical problems is NOT typically associated with peritonitis?

    <p>Impaired Respiratory Function (A)</p> Signup and view all the answers

    What is NOT a common cause of secondary peritonitis?

    <p>Cirrhosis with ascites (A)</p> Signup and view all the answers

    Which of the following is a common diagnostic procedure for peritonitis?

    <p>Abdominal paracentesis and culture of fluid (B)</p> Signup and view all the answers

    What is the main purpose of NG suction in the management of peritonitis?

    <p>To decrease gastric distention (B)</p> Signup and view all the answers

    Which of the following is NOT a common nursing intervention for a patient with peritonitis?

    <p>Performing lumbar puncture (D)</p> Signup and view all the answers

    What is the most common reason for surgical intervention in cases of peritonitis?

    <p>To locate the cause of inflammation (A)</p> Signup and view all the answers

    Which of the following is a potential complication of peritonitis?

    <p>Hypovolemic shock (B)</p> Signup and view all the answers

    Patients receiving conservative care for peritonitis typically receive which of the following?

    <p>Antibiotics, NG suction, analgesics, and IV fluid administration (C)</p> Signup and view all the answers

    Positioning the patient with knees flexed can help to increase comfort in individuals with peritonitis. Why is this recommended?

    <p>Reduces abdominal pressure (B)</p> Signup and view all the answers

    What is the primary role of the patient's history and physical assessment in diagnosing peritonitis?

    <p>To identify the cause of the inflammation (D)</p> Signup and view all the answers

    Study Notes

    Peritonitis: Etiology and Pathophysiology

    • Peritonitis is inflammation of the peritoneum, caused by contamination with bacteria, chemicals, or both.
    • Primary peritonitis: Blood-borne organisms enter the peritoneal cavity, unrelated to other intraabdominal issues. Ascites (fluid buildup), as in cirrhosis, creates a bacterial breeding ground.
    • Secondary peritonitis: More common, caused by perforated or ruptured abdominal organs (appendix, ulcer, diverticulitis, trauma). Organ contents (bile, enzymes, bacteria) contaminate the cavity. Initial chemical irritation is followed by bacterial peritonitis.
    • Inflammation triggers fluid shifts, edema, and adhesions (body's attempt to wall off infection).

    Clinical Manifestations

    • Severe, continuous abdominal pain is the most common symptom.
    • Tenderness over the affected area is a universal sign.
    • Rebound tenderness, rigidity, and muscle spasm indicate peritoneal irritation.
    • Patients often lie still and breathe shallowly due to pain exacerbation with movement.
    • Other symptoms include abdominal distension, fever, tachycardia, tachypnea, nausea, vomiting, and altered bowel habits.
    • Symptoms vary depending on condition severity and acuteness.
    • Possible complications include hypovolemic shock, sepsis, intra-abdominal abscesses, paralytic ileus, and acute respiratory distress syndrome.
    • Untreated peritonitis can be fatal.

    Diagnostic Studies and Interprofessional Care

    • Complete Blood Count (CBC): Used to assess elevated white blood cell count (WBC) and hemoconcentration from fluid shifts.
    • Peritoneal aspiration: Fluid analysis for blood, bile, pus, bacteria, fungus, and amylase.
    • Abdominal X-ray: May reveal dilated bowel (paralytic ileus), free air (perforation), or air/fluid levels (obstruction).
    • Ultrasound and CT scans: Used for identifying ascites and abscesses.
    • Peritoneoscopy: A method of direct peritoneum examination (useful in patients without ascites) enabling biopsy for diagnosis.
    • Conservative management: For milder cases or patients at high surgical risk, comprising antibiotics, nasogastric (NG) suction, analgesics, and IV fluids.
    • Surgical intervention: For severe cases, involves locating the cause, draining pus, and repairing damage (perforated organs).

    Common Causes of Peritonitis (Table 47.14)

    • Primary: Blood-borne organisms, cirrhosis with ascites.
    • Secondary: Ruptured appendix, blunt/penetrating abdominal trauma, ruptured diverticulitis, intestinal cancer, ischemic bowel disorders, pancreatitis, perforated intestine, uterus, bladder, stomach, perforated peptic ulcer, peritoneal dialysis, postoperative complications (anastomosis breakage).

    Nursing Management: Peritonitis

    • Assessment: Focus on pain (location, quality), bowel sounds, abdominal distension, guarding, nausea, fever, and signs of hypovolemic shock.
    • Clinical Problems: Pain, fluid imbalance, impaired GI function, risk for infection.
    • Goals: Resolution of inflammation, pain relief, prevention of complications (sepsis, hypovolemic shock), normal nutrition.
    • Implementation: Establish IV access and monitor for pain & response to analgesics. Position patient with knees flexed for comfort. Monitor intake/output (I&O), electrolytes, vital signs, and oxygen requirements. Administer antiemetics, maintain NPO status (possibly NG tube for decreased distension), and consider drains for open procedures.

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    Description

    This quiz delves into the causes and mechanisms of peritonitis, a serious inflammation of the peritoneum. Participants will explore both primary and secondary peritonitis, understand the clinical manifestations, and recognize the signs that indicate peritoneal irritation. Test your knowledge on this critical topic in healthcare.

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