Understanding Peritonitis

Peritonitis

• Peritonitis is a disease where contents irritate the peritoneum
• WBCs move toward the irritation
• Fluid moves to the area and into intravascular spaces
• Adhesions develop

Peritonitis Complications

• Sepsis
• ARDS
• Disseminated intravascular coagulation
• Hypovolemic shock
• Metabolic alkalosis
• Abscess
• Bowel obstruction
• Respiratory distress

Peritonitis Signs and Symptoms

• Abdominal pain
• Fever
• Distended abdomen
• Altered bowel sounds
• Hypotension
• Tachycardia

Labs and Diagnostics for Peritonitis

• False elevation may occur due to fluid shift
• Hemoglobin and hematocrit levels
• White blood cell count
• Peritoneoscopy
• Computed tomography scan
• Urinalysis

Nursing and Medical Interventions for Peritonitis

• Perform abdominal assessment
• Apply cold towels or remove blankets
• Manage risk for falls
• Monitor orthostatic vital signs
• Administer pain medication and Tylenol
• Nasogastric tube insertion
• Intravenous fluids
• Therapeutic paracentesis

Types of Peritonitis

• Primary peritonitis is often blood-borne, related to ascites and cirrhosis
• Secondary peritonitis happens where there's a perforation of an organ that spills contents into the internal cavity

Patient Education for Peritonitis

• Ruptured appendix, stab wound, and ulcer perforation causes peritonitis

Large Bowel Obstruction (LBO)

• A large bowel obstruction (LBO) can be nonmechanical or mechanical

LBO Pathophysiology and Etiology

• Fluid, gas, and intestinal contents back up proximally causing proximal bowel distention
• There is reduced fluid absorption and increased intestinal secretion
• Distal bowel empties and collapses
• There is increased pressure in the bowel lumen, leading to capillary permeability
• Extravasation of fluids and electrolytes occurs into the peritoneal cavity

LBO Can Result in

• Decreased circulating blood volume
• Hypotension and hypovolemic shock

Signs and Symptoms of LBO

• Can include metabolic alkalosis or metabolic acidosis
• Gradual onset
• Vomiting is rare
• Persistent cramping and lower abdominal pain
• No stool production
• Complete or partial Obstipation
• Abdominal distention becomes noticeable

Four Hallmark Symptoms of LBO

• Abdominal pain
• Nausea and vomiting
• Distention
• Constipation

LBO: Labs and Diagnostics Include

• Bleeding may increase or decrease hematocrit
• X-rays, CT scan, and contrast enema
• Sigmoidoscopy and colonoscopy may be performed
• White blood cell count may indicate strangulation or perforation

LBO: Nursing Interventions Include

• Goal is to regain internal patency
• Depending on the case: Emergency surgery, resection, partial or total colostomy or ileostomy, colonoscopy, NG decompression, IV hydration, Potential need for parenteral nutrition for long periods

Move These Medical Interventions from Nursing Interventions

• Colonoscopy removes polyps or dilates strictures
• NG Decompression to reduces bowel distention
• IV Hydration
• Parenteral Nutrition (PUN) if obstructed for long time

LBO: Complications

• Perforated bowel requires immediate treatment to avoid sepsis and death

Acute Pancreatitis

• Complication that can result in both pancreatic abscess and psuedocyst

Acute Pancreatitis Pathophysiology and Etiology

• Includes acute inflammation and gallbladder stones blocking bile potentially
• Spillage of pancreatic enzymes into surrounding pancreatic tissue causes autodigestion and severe pain
• Varies from mild edema to severe hemorrhagic issues
• There is less common a drug reaction that causes pancreacitits
• Less common for pancreatic cancer to cause it

Acute Pancreatitis Can Be Cause by

• Gallbladder disease
• Chronic alcohol use
• Hypertriglyceridemia (>1000)

Signs and Symptoms of Acute Pancreatitis

• Abdominal pain predominates in the lower left upper quadrant (LLUQ) and mid-epigastric regions
• Radiates to the back with sudden onset and deep, piercing, and constant pain
• Pain worsens after eating and stays when lying down
• Abdominal guarding
• Cyanosis, dyspnea, and crackles

More Symptoms of Acute Pancreatitis

• Nausea, vomiting
• Possible absent bowel sounds
• Abdominal guarding
• Flushing skin, low-grade fever
• Tachycardia and hypotension
• Jaundice and abdominal skin discoloration
• Grey Turner's or Cullen's sign

Acute Pancreatitis Labs and Diagnostics

• Serum amylase level (most sensitive, elevates within 24 hours, return to normal after 5-7 days)
• Serum lipase level (primary diagnostic marker, normal after 5-7 days), billburin, liver enzyme levels, triglyceride levels

Nursing Interventions for Acute Pancreatitis

• Flex trunk and knees to belly or pain medication
• Aggressive hydration at 250 mL/hr with intravenous lactated ringer (LR) or normal saline (NS)
• Management of metabolic complications
• Monitor blood glucose, minimizing stimmianon

NO Morphine

• Use only one-of morphine for patients with gallstone

Frequent Oral and Nasal Care

• Frequent oval and nasal care is necessary because patients is NPO
• More susceptible to infection

Biliary Tract Disease: Cholelithiasis

• Exact cause of gallstones unknown and they develop from cholesterol, bile salts bilirubin, Ca+, protein
• Stones may stay in gallbladder or migrate to cystic or common bile ducts

Cholelithiasis Pathophysiology

• Stones cause pain as pass through ducts
• Stones that lodge in ducts will cause obstructions and that can cause further problems
• Cholecystitis, obstructive jaundice, elevates lactic acid and pancreas depending on the location

Cholelithiasis: Choledocholithmiasis

• Choledocholithmiasis = gallbladder obstruction of common bile duct

Biliary Tract Disease: Varies from Severe to None: Signs and Symptoms Can Include

• Pain moves to severe when stones are moving or obstructing
• 3-6 hrs of tor & fat meal or pt lies down
• Steady excruciating
• Tachycardia, diaphoresis, prostration
• Pain shifts about Iwv, then residual tenderness in RUQ
• Refereed to shoulder, scapula

Biliary Tract Disease Additional Signs and Symptoms

• Indigestion
• Nausea and vomiting
• Abdominal distention and rigidity or guarding
• Diaphoresis with liver congestion
• Jaundice and pruritus
• Fat intolerance
• Dyspepsia
• Heartburn and flatulence when total obstruction occurs, bile builds up bilirubin is not excreted so there is hyperbilirubinemia
• If there is inflammation with fever and chills, indicates leukocytosis

Biliary Tract Disease: Risk Factors Include

• Female, multiparty, estrogen therapy
• 40
• Sedentary lifestyle, obesity, and familial tendency
• Diet is saturated fat, large, fatty meals or rapid weightloss
• Avoid large, fatty meals and take in fiber and Ca+

Small Frequent Meals

• Small frequent meals are always best avoid large meals and saturated fats
• Give intravenous liquids to regain normal bowel sounds

Risk Factors After Laparoscopic Intervention

• Light meals are needed for few days
• If patients over weight, calories should be restricted by being careful
• Liquids are needed
• May need to restrict fats for 4-6 wks

Nursing Interventions for Biliary Tract Disease

• Meds: Antibiotics, analgesics-opiods, anticholinergic or antimencl, bile salts, antihistamines
• Monitor for infection or bleeding
• Maintain fluid and electrolyte balance
• Manage surgical drains, ensure that ducts have potency to allow bile to drain
• Ensure patient is doing isometric exercises

Treat Biliary Tract Disease with Surgery

• Laparoscopic cholecystectomy or Incisional cholecystectomy
• T-tube insertion into common bile dou ensures parency and allows bile to drain

POST OP: VS: for Biliary Tract Disease

• Monitor the vitals , assess and treat pain, encourage I.S. coughing

Patient Comfort: Biliary Tract Disease

• Keep patient NPO and lower fat diet
• Maintain reference for pain from to shoulder from carbon dioxide
• Keep patient in Sims position

MORE Pathophysiology and Etiology

• Cholecystitis is inflammation of the gallbladder most often associated with obstruction from stones
• Can be acalculous
• Older adults with other clinicallly-ill conditions

Potential Biliary Tract Disease Changes:

• Involves only mucous lining or entire wall
• Gallbladder is edematous
• Hyperemic
• Contain bile or pus
• Cystic duck will become occulded
• Scarring and fibrosis after attacks

Complications Cholelithiasis Can Cause

• Cholelithiasis causes cholecystitis, subphrenic abscess, fistula, cholangitis and obstructive problems
• May also lead to pancreatitis, transaminitis, and biliary cirrhosis