Praise and thanksgiving we pray to God Almighty who has given us deliciously healthy physically and spiritually so that we can complete this task. Our gratitude also say the father Ns. Supadi, M.Kep, SP.MB lecturer in adult nursing has given us the opportunity to add to our insight. In the paper contains the "peritonitis", we expect criticism and suggestions so that we can be better. Hopefully, this paper can be useful for pe reed and especially for writers.

Cirebon, 30 October 2010

Drafting team



....................................... 1 1.................................4 2................................................ .............3 2.................2........... ................7 Examination Support ........ BACKGROUND ................1........... Bibliography CHAPTER I INTRODUCTION 1...................Word Table of contents ii CHAPTER I Introduction 1........................... 2 CHAPTER II Pe mbahasan 2........ 11 2..2....... 13 2:11 D ampak KDM .................. ... .................... 16 3...... 10 2.... ......... ..................................................1 2.............................. This situation requires an ... .. Purpose .......................1...... ...........5 Signs and Symptoms .....1 Background Acute abdominal describe the state of the clinic due to gravity in the abdominal cavity which usually occur suddenly with pain as the main complaint............8 Emerging Nursing Diagnosis ........................................ 13 CHAPTER II I Cover 3... Conclusion .................................................... 11 2:10 Medical Management ...............2 2.......................

contamination of continuous.2 Purpose of Writing . resistance decreases. also by ileus obstructive. obstruction and strangulation of the gut can lead to perforation of the resulting in contamination of the abdominal cavity by the contents of the gastrointestinal tract so there was peritonitis. gastroduodenal ulcer perforation). postoperative complications. for example in perforation. ischemia and bleeding. Peritonitis caused by abnormalities in addition to the abdominal inflammation and penyulitnya form. The decision to perform surgery should be taken because any delay will cause disease result in increased morbidity and mortality. Inflammation of the peritoneum is a dangerous complication often occurs due to spread of infection from the abdominal organs (Eg. physical examination and investigation.immediate response is often in the form of surgery. or out of penetrating abdominal wounds. the peritoneum resistant to bacterial infection (A small-scale inoculation). salpingitis. In writing Referat will be discussed on the handling peritonitis. Accuracy diagnosis and mitigation depends on the ability perform analysis on the data history. gastrointestinal rupture. infection. appendicitis. chemical irritation. Some disorders caused by direct or indirect injuries resulting Gastrointestinal perforation or bleeding. intra-abdominal bleeding. 1. In normal circumstances. virulent bacteria. and the object foreign or active digestive enzymes. are all factors that facilitate the occurrence of peritonitis.

and the authors hope that students understand not only the disease but students can also find out the cause of the symptoms treatment and prevention of diseases in particular experienced peritonitis disease. and general signs inflammation.1 Peritonitis Peritonitis is inflammation of peritoneum-layer serous membrane abdominal cavity and covers the viscera is a complication danger that can occur in the form of acute or chronic / collection of signs and symptoms. defans muscular. Peritonitis is often caused by an infection inflammation sekitarnyah environment through bowel perforation as rupture appendix or . Peritonitis is an inflammation of the membrane process serosa surrounding the abdominal cavity and the organs are located didalamnyah. such as tenderness and pain off on palpation. especially the peritoneum.The purpose of this paper is that students can understand the disease occurs in the abdominal organs. CHAPTER II DISCUSSION 2.

the higher the risk of peritonitis and abscess. This occurs because the bond opsonization low molecular components between the pathogen ascites often cause infections are gram-negative bacterium E. Pseudomonas species. not from organ abnormalities. SBP is not due to intra-abdominal infection n. It can also be caused by material irritan chemicals such as acid from the stomach ulcer perforation or bile from the liver laceration empeduatau perforated bag. More and more low ascitic fluid protein levels. 2.diverticulum as originally peritonitis is a sterile environment. sometimes there is haematogenous spread if occurs due to bacteremia and chronic liver disease. in patients peritonisis tertiary or flagmon abscess usually occurs with or without fistula. another 15% type of Streptococcus. Tertiary peritonitis due peritoneal infection repeated after getting treatment SBP or secondary peritonitis Adequate.2 Etiology The most frequent forms of peritonitis Spontaneous B is acterial Peritonitis (SBP) and secondary peritonitis. 7% Klebsiella pneumoniae. Staphylococcus and group 3%. but it also contained anaerobic and mixed bacterial infection. Proteus and the other 20% gram and gram-positive bacteria are Streptococcus pnemuminae 15%. but usually occurs in patients ascites peritoneal contamination to kerongga sehinggan translocation of bacteria into the abdominal wall or vessel munuju mesenteric lymph nodes. In addition. Coli 40%. Cases of acute peritonitis untreated can be fatal. sterile . Secondary peritonitis most often is caused by perforation or necrosis (transmural infection) organs in the peritoneal cavity with bacteria inoculation mainly due to gram-positive bacteria derived from the channel upper gastrointestinal. On she is very possible localized peritonitis in the cavity Pelvic infection of fallopian tube or ovarian cyst rupture. there is a TB peritonitis.

Because body tries to compensate by way of retention fluid and electrolytes by the kidneys. Cause inflammation and fluid accumulation due to capillary membranes undergo leakage. Pockets of pus (abscess) formed between fibrinous adhesions. which attaches to one with the surrounding surface so as to limit the infection. waste products also accumulate. and other chemical substances or prses transmural inflammation of internal organs (eg disease Crohn's). such as interleukins.3 Pathophysiology The initial reaction to invasion by bacteria peritoneum is fibrinous exudate discharge. . but can persist as fibrous bands. which can later be result in bowel obstuksi. 5 The organs in the peritoneal cavity. Edema caused by capillary permeability these organs rising. If the fluid deficit is not corrected quickly and aggressively. barium. it can cause cell death. The release of various mediators. but This soon failed so happens hypovolemia. The attachment usually disappears when the infection disappeared. may start hiperinflamatorius response. Tachycardia initially increase cardiac output. 4 2. including the wall experiencing abdominal edema. such as bile.peritonitis or chemical irritation occurs due to chemicals. so as to bring into subsequent development of many organ failure. The collection of fluid in the peritoneal cavity and intestinal lumens and whole organ edema and intra peritoneal edema.

abdominal wall including retroperitoneal tissue cause hypovolemia. it can arise peritonitis general. Some germs destroyed by stomach acid. Ileus Ileus may be as simple as bowel obstruction were not accompanied pinched blood vessels and can be total or partial. intestine and be Atoni and stretch. 6 Abdominal typhus is an acute infectious intestinal disease that caused by germs S. Hypovolemia increases with an increase in temperature. circulatory disorders and oliguria. more further increase intra abdominal pressures. Fluids and electrolytes lost into intestinal lumen.Terjebaknya fluid in the peritoneum cavity and intestinal lumen. make the effort full breathing difficult and cause a decrease perfusion. ileal perforation in typhoid fever usually occurs in patients who have . and muntah. some into keusus smooth and achieve plaque peyeri lymphoid tissue in the ileum terminalis experiencing complications hypertrophy this place intestinal bleeding and perforation may occur. shock. Long intestinal blockage or obstruction in the intestine can cause ileus due to mechanical disruption (blockage) then an increase in intestinal peristalsis in an effort to overcome obstacles. resulting in dehydration. activity peristalsis is reduced to arise paralytic ileus. If the material is widespread on the surface of infected peritoneum or when the infection spreads. The attachment can be formed between the arches intestines are stretched and can interfere with recovery bowel movements and cause intestinal obstruction. on stangulasi ileus obstruction accompanied pinched blood vessels resulting in ischemia in the will end up with necrosis or gangrene and eventually and bowel perforation due to the spread of bacteria on the cavity abdomen that can occur peritonitis. With the development of generalized peritonitis. the input that does not exist. Typhi that enter the human body through mouth from contaminated food and water.

In both penetrating trauma abdominal trauma and abdominal trauma blunt abdominal peritonitis can lead to sepsis when the intra peritonial hollow organs. diapedesis bacteria. tenderness. Then spread throughout the stomach cause pain throughout the abdomen in early perforation. Obstruction is causes mucus produced mucosal experienced dam. and venous obstruction that edema increases then the flow will be disrupted arterial wall infarction appendix followed by necrosis or gangrene of the wall appendix and eventually causing perforation resulting in local or general peritonitis. and a general state of decline due to toxemia. Perforation of peptic ulcer characterized by stimulation of the peritoneum which began in the epigastrium and extends throughout the peritoneum due generalized peritonitis. no bacterial infection. cough and malaise followed by abdominal pain. foreign objects. this will reduce complaints for a while until then occurred bacterial peritonitis. Perforation of the stomach and duodenum sections front causing acute peritonitis. but elasticity of the walls of the appendix has limitations that causes increased intraluminal pressure and inhibit lymph flow resulting in edema. Painful suddenly arises mainly felt in the epigastrium because stimulation of peritoneum by stomach acid. mucosal ulceration. The absence of pain in the shoulder show excitability peritoneum mengenceran form that stimulates acid salt. Patients who experience perforation looks great pain like being stabbed in the stomach. stricture due to fibrosis and neoplasms.fever during approximately 2 weeks with headache. sometimes called phase phase chemical peritonitis. fekalit. defans muscular. bile and or pancreatic enzymes. Peritonial stimuli arising in . 7 In appendicitis usually is usually caused by a blockage appendix lumen by lymphoid follicle hyperplasia. the longer the mucus is more and more.

immunosuppression and splenectomy. usually E.4 Classification Based on the pathogenesis of peritonitis can be classified as the following: A. Peritonitis Bacterial primer is divided into two. . no early phenomenon occurs because microorganisms need time to new breed after 24 hours of onset of symptoms of acute abdomen because stimulation peritoneum.accordance with the contents of the organ hollow. namely: Specific: eg Tuberculosis 8 2. When perforation occurs section above. such as the stomach area there will be a stimulation immediately after the trauma and symptoms of peritonitis will be great whereas when the bottom like the colon. intra-abdominal malignancy. Risk factors that contribute to this is the presence of peritonitis malnutrition. Sreptococus or Pneumococus. Coli. ranging from the nature of gastric chemistry to the colon that contains feces. 2. Non specific: for example. The reason is monomikrobial. Peritonitis B akterial P Rimer 1. Chemical stimulus onset fastest and slowest feces. non tuberculosis pneumonia an Tonsillitis. Is a bacterial peritonitis due to contamination by haematogenous the cavum peritoneum and not found us k fo infection in the abdomen.

which caused by material chemical. B. gastric sap. Synergism from multiple organisms can aggravate this infection. Tertiary Peritonitis. for example:  9 Peritonitis caused by fungi  Peritonitis source of the bacteria that can not be found. for example appendicitis. Bakterii anaerobes. bowel perforation so that the stool out of the colon. Peritonitis is caused by a direct irritant. can increase the influence of aerobic bacteria in causing infection. Another form of peritonitis peritonitis:  Aseptic / sterile peritonitis  Granulomatous peritonitis . systemic lupus erythematosus.  Complications of the inflammatory process intra-abdominal organs. sepertii such as bile. In general organism not only will cause peritonitis. and urine. sap pancreas. C. which carry germs from the outside in. chronic renal failure.High-risk groups are patients with nephrotic syndrome. Besides an extensive and long-contamination of bacteria can also be aggravate a peritonitis. such as peritonitis. Peritonitis B akterial A kut S ekunder (S upurativa) Peritonitis which follows an acute infection or perforation tractusi gastrointestinal or urinary tract. Germs can be derived from:   Injury / trauma penetration. and cirrhosis hepatis with ascites. especially Bacteroides species. into the peritoneal cavity. Perforation of the organs in the abdomen. which fatal. D.

septic shock. The abdominal wall will feel tense because anticipation mechanism for the patient unconsciously palpasinya avoid a convincing or tense because irritation peritoneum. or HIV). steroid use. In women vaginal examination bimanual pelvic pain due to distinguish inflammatoru disease. patients with decreased consciousness (eg cranial trauma. Test lab Leukocytosis .7 Examination Support 1. dehydrated to be hypotension. dnegan paraplegia patient and geriatric patients. or the use of analgesics).6 Complications Eviserasi Wounds Abscess formation 2. 10th 2. pascatransplantasi. toxic encephalopathy. Abdominal pain Great place usually has a certain maximum punctum as a source of infection. Clinical examinations may be a false positive in patients in a state of immunosuppression (eg diabetes severe. tatikardi. Hiperlipidemik peritonitis  Talc peritonitis 2.5 Signs and Symptoms Signs of peritonitis infection relative to the weight of the high fever or sepsis patients who could be hypothermia.

Free air in the abdominal cavity seen in the case of perforation. Small intestine and colon dilatation. give narcotics.  Maintain bed rest.8 Emerging Nursing Diagnosis 1. break. fever and tissue damage Purpose: Client's perception of pain decreases. lateral).Hematocrit increased Metabolic acidosis 2.9 Intervention Nursing Diagnosis I: 11th Pain bd inflammatory process. obtained: I ll EUS is an invention that is not typical of peritonitis. analgesics and sedatives appropriate programs to improve comfort and rest. and not wince. Pain bd inflammatory process. 2. marked reduction in pain scale. Changes in nutrition less than body requirements bd vomiting and sucking intestines. Ray Plain abdominal 3 position (anterior. fever and tissue damage. X. 2. Intervention:   Assess and record the character and severity of pain every 1-2 hours After the diagnosis. 2. quiet neighborhood. posterior. .

  When programmed to support patients with parenteral nutrition. Purpose: Adequate nutrition patients.5 g / dl. Maintain a comfortable position. 12th  Give liquids in stages when motility has returned.5 s / d 5. NG tube will be installed to decompress the abdomen. Intervention:    Maintain appropriate patient fasting during the acute phase of the program. serum albumin 3. semifowler. the oral fluids and avoid liquids vein to replace electrolytes and protein loss. Usually intestinal tube inserted through the nose into the intestine to reduce the pressure in the colon. electrolytes and vitamins according to the program. marked BB stable. proven bowel sounds. When widespread peritonitis and surgery is contraindicated due to shock and circulatory failure. Nursing Diagnosis II: Changes in nutrition less than body requirements bd vomiting and sucking intestines. decreased distension and passage of flatus. When experiencing ileus. 2:10 Medical Management 1. . Give a replacement fluid.

3. Because these tests take time. → serotonin causes infection → stimulation of nerve endings (nociseptor) → afferent nerves Thalamus Cortex cerebri → afferent nerves Pain perception → Painful 13th 2:12 Treatment The general principles of therapy in peritonitis are: a) b) Replacement of lost fluids and electrolytes made intravenously. histamine. If the perforation is not prevented. Surgery may be done to prevent peritonitis. . such as ampicillin and others. surgical intervention is a major incision and drainage of the abscess. When the infection began to subside and the patient's condition improved.2. Antibiotic therapy plays a very important role in the treatment of puerperal infection. In this case can be given penicillin in high doses or with broad-spectrum antibiotics. 2:11 D ampak KDM Ruptured perineu → Wound → Network → breakdown in continuity facilitate microorganisms entry into the body Spending → substances of chemical mediators → germs breed → Bradykinin. then treatment should be initiated without waiting for the results. and surgical drainage improvements can be pursued. as apendiktomi.

In inflammation of the pancreas (acute pancreatitis) or pelvic inflammatory disease in women. Directed to excision surgery. Oxygen therapy by nasal cannula or mask will improve oxygenation is adequate. resection with or without anastomosis (colon). . and if necessary blood transfusions performed. improving on the experience peptic ulcer perforation or diverticulitis and abscess drainage. food containing substances required should be given in a way that matches the circumstances of the patient. some antibiotics given concurrently. emergency surgery is usually not performed. but sometimes the airway intubation and ventilatory support is needed.c) Analgesic therapy given to treat pain. In addition to treatment with antibiotics. Bowel intubation and suction helps in eliminating abdominal distention and improve bowel function. especially if there is appendicitis. Given appropriate antibiotics. d) 14th Surgery include infection of the material and correct the cause. if necessary. Fluid in the abdominal cavity can cause pressure to limit the expansion of the lungs and cause respiratory distress. Care is essential. Antiemetics can be given as a treatment for nausea and vomiting. measures to enhance the durability of the body still needs to be done.

In sellulitis pelvika and pelvioperitonitis have scrutinized carefully whether there is an abscess or not. clear membrane covering the abdominal organs and the abdominal wall. 2:13 Prognosis The prognosis for peritonitis is both local and lightweight. pelvic inflammatory disease in women who are still active in sexual activity. infection of . Peritonitis are localized only in the pelvic cavity called pelvioperitonitis. If there is an abscess. The cause of peritonitis include: the spread of infection from an infected abdominal organs.1 Conclusion Peritonitis is inflammation of the peritoneum which is wrapping the viscera in the abdominal cavity. 15th CHAPTER III CLOSING 3 . while the general prognosis lethal peritonitis due to virulent organisms. abscess must be opened to keep the pus does not enter into the peritoneal cavity and blood vessels rather large not to hurt. The peritoneum is a thin.

Patofisologi peritoneum peritonitis was the initial reaction to bacterial invasion is the release of fibrinous exudate. which stick together with the surrounding surface so as to limit the infection. but it can be settled as fibrinous bands. irritation without an infection. Analgesic therapy given to treat pain. d) Surgery include infection of the material and correct the cause.the uterus and fallopian tubes. Formed pockets of pus (abscess) among fibrinous adhesions. b) c) Antibiotic therapy plays a very important role in the treatment of puerperal infection. . 3 . peritonitis can occur after a surgery. peritoneal dialysis (treatment fails kidney). The attachment usually disappears when the infection disappear. which later can cause intestinal obstruction. The general principles of therapy in peritonitis are: a) 16th Replacement of lost fluids and electrolytes made intravenously. abnormal liver or heart failure.2 Suggestions We as a nurse in addressing the problem of peritonitis in the community can provide a variety of ways to prevent peritonitis and expected student / i can provide nursing care to clients experiencing particularly peritonitis in accordance with what is learned.

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