SGT UNIVERSITY

GURGRAM HARYANA
FACULTY OF NURSING

PERFORATIVE PERTIONITIS

SUBMITTED TO: - SUBMITTED BY: -

Ms. KAVITA PILLAI DEEPAK RATHEE
Assistant professor M.sc Nursing 2nd year
210424005
 Introduction

Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the
abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused
by infection from bacteria or fungi.

Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of
perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The
diagnosis is mainly based on clinical grounds.

Left untreated, peritonitis can rapidly spread into the blood (sepsis) and to other organs, resulting
in multiple organ failure and death. So, if you develop any of the symptoms of peritonitis -- the
most common of which is severe abdominal pain -- it's essential to seek prompt medical
evaluation and treatment that can prevent potentially fatal complications.
Perforated – Small hole or Multiple Holes
Peritoneum – serous membrane lining of the cavity of the abdomen
Type of Membrane
1) Epithelial Tissue
2) Mucous
3) Serous
4) Connective Tissue
5) Synovial
6) Meninges

Type of perforation

 spontaneous bacterial peritonitis (SBP)

 secondary peritonitis
 aseptic (or sterile) peritonitis

SBP is the result of an infection of the fluid in your peritoneal cavity.

Secondary peritonitis is usually due to an infection that’s spread from your digestive tract.

Aseptic peritonitis isn’t associated with infection.

The two main types of peritonitis

1 Primary spontaneous peritonitis, an infection that develops in the peritoneum

2 secondary peritonitis, which usually develops when an injury or infection in the abdominal
cavity allows infectious organisms into the peritoneum.

Both types of peritonitis are life-threatening. The death rate from peritonitis depends on many
factors, but can be as high as 40% in those who also have cirrhosis. As many as 10% may die
from secondary peritonitis.

Causes of Peritonitis
Liver disease with cirrhosis. Such disease often causes a buildup of abdominal fluid (ascites)
that can become infected.

Kidney failure getting peritoneal dialysis. This technique, which involves the implantation of a
catheter into the peritoneum, is used to remove waste products in the blood of people with
kidney failure. It's linked to a higher risk of peritonitis due to accidental contamination of the
peritoneum by way of the catheter.

Common causes of secondary peritonitis include:

 A ruptured appendix, stomach ulcer

 Digestive diseases such as Crohn's disease and diverticulitis
 Pancreatitis
 Pelvic inflammatory disease
 Perforations of the bowel, stomach, intestine, gallbladder, or appendix
 Surgery
 Trauma to the abdomen, such as an injury from a knife or gunshot wound

Noninfectious causes of peritonitis include irritants such as bile, blood, or foreign substances in
the abdomen, such as barium.

Pathology
1. Due to causative agent (Bacteria, Fungus)
2. Affect Digestive system
3. Perforated peritoneum
4. Spread of infection into blood stream
5. Multiple organ failure
6. Death

Symptoms of Peritonitis
The first symptoms of peritonitis are typically poor appetite and nausea and a dull abdominal
ache that quickly turns into persistent, severe abdominal pain, which is worsened by any
movement.

Other signs and symptoms related to peritonitis may include:

 Abdominal tenderness or distention

 Chills
 Fever
 Fluid in the abdomen
 Not passing any urine, or passing significantly less urine than usual
 Difficulty passing gas or having a bowel movement
 Vomiting


Diagnosis of Peritonitis
It’s a life-threatening disease so call your doctor right away.

Diagnostic tests for peritonitis may include:

 Blood and urine tests

 Imaging studies such as X-rays and computerized tomography (CT) scans
 Exploratory surgery

Your doctor also may perform a paracentesis, a procedure in which fluid from the abdominal
cavity is withdrawn through a thin needle and checked for infection. Paracentesis is useful for
identifying primary spontaneous peritonitis and secondary peritonitis caused by pancreatitis.

Treatments for Peritonitis

Intravenous antibiotics or antifungal medications to treat the infection.

Medications. Administration of analgesic and anti-emetics can be done as prescribed.

Additional supportive treatments will be necessary if organ failure from sepsis develops as a
complication of the infection. Such treatments may include intravenous fluids, drugs to maintain
blood pressure, and nutritional support.
If you have peritoneal dialysis-associated peritonitis, you may receive medications that are
injected directly into the peritoneal space, a strategy that some studies have reported to be more
effective than intravenous medications. 

In many cases, emergency surgery is required, especially if peritonitis has been caused by
conditions such as appendicitis, a perforated stomach ulcer. Infected tissue such as a burst
appendix or abscess will be surgically removed. So will any part of the peritoneal tissue that has
been seriously damaged by infection.

During your hospitalization, you will be closely monitored for signs of sepsis and septic shock,
which usually require immediate transfer to an intensive care unit

Preventing Peritonitis
Patient with cirrhosis and ascites, Antibiotics to prevent peritonitis.

Preventive self-care technique to prevent peritoneal dialysis

If you're receiving peritoneal dialysis, you can lower your risk of peritonitis by following these
tips:

 Thoroughly wash your hands, including the areas between your fingers and under your
fingernails, before touching the catheter.
 Wear a mouth/nose mask during exchanges.
 Observe the proper sterile exchange technique.
 Apply an antibiotic cream to the catheter exit site every day.

Immediately report any possible contamination of your dialysis fluid or catheter to your
peritoneal dialysis nurse. In many cases, a single dose of antibiotics can prevent a contamination
from turning into an infection

NURSING MANAGEMENT

 Blood pressure monitoring. The patient's blood pressure is monitored by arterial line if
shock is present.
 Pain management. ...
 I&O monitoring. ...
 IV fluids. ...
 Drainage monitoring.